1316231608 NPI number — GEORGE T BESONG MD OB/GYN LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316231608 NPI number — GEORGE T BESONG MD OB/GYN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGE T BESONG MD OB/GYN LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WOMEN'S HEALTH RESOURCE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316231608
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2728 ENTERPRISE RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
ORANGE CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32763-8276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-774-0109
Provider Business Mailing Address Fax Number:
386-774-1203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2728 ENTERPRISE RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ORANGE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32763-8276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-774-0109
Provider Business Practice Location Address Fax Number:
386-774-1203
Provider Enumeration Date:
06/03/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BESONG
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
TATAW
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
386-279-0060

Provider Taxonomy Codes

  • Taxonomy code: 207PE0004X , with the licence number:  ME123086 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: ME123086 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207VF0040X , with the licence number: ME92729 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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