Provider Demographics
NPI:1912961269
Name:CHEESEMAN, GEORGE R III (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:R
Last Name:CHEESEMAN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:813-528-4975
Mailing Address - Fax:
Practice Address - Street 1:7229 US HIGHWAY 301 S
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-4346
Practice Address - Country:US
Practice Address - Phone:813-677-8418
Practice Address - Fax:813-355-5906
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME75760207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265948400Medicaid
FLP01202204OtherR&R MEDICARE
FL62913WMedicare PIN