Active NPI
George Otto Mabry Jr, D.P.M.
- Primary Podiatric Medicine Podiatrist
- Indian Harbour Beach, FL
National Provider Identifier
1023079688
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Podiatric Medicine Podiatrist
- License
- PO2788
- Practice address
- 2194 Hwy A1A
Suite 108
Indian Harbour Beach, FL 32937-4930 - Phone
- (321) 777-9559
- Fax
- (321) 777-9558
- NPI assigned
- Mar 31, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Podiatric Medicine Podiatrist | 213EP1101X | PO2788 | FL | Primary |
| Radiology Podiatrist | 213ER0200X | JR3863700 | FL |
Addresses
Primary practice location
2194 Hwy A1A
Suite 108
Indian Harbour Beach, FL 32937-4930
Mailing address
2194 Hwy A1A
Suite 108
Indian Harbour Beach, FL 32937-4930
Phone (321) 777-9559
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 65612 | Other | FL | BCBS ID |
| 2900719 | Other | FL | AETNA HMO/QPOS ID # |
| 7781081 | Other | FL | AETNA PPO/POS ID # |
| 340672500 | Medicaid | FL | |
| 0380220001 | Other | FL | CIGNA ID # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PO2788 | FL | MD | Primary Podiatric Medicine Podiatrist |
| JR3863700 | FL | MD | Radiology Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1482796800000",
"number": "1023079688",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2194 HWY A1A",
"address_2": "SUITE 108",
"city": "INDIAN HARBOUR BEACH",
"state": "FL",
"postal_code": "329374930",
"telephone_number": "321-777-9559",
"fax_number": "321-777-9558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2194 HWY A1A",
"address_2": "SUITE 108",
"city": "INDIAN HARBOUR BEACH",
"state": "FL",
"postal_code": "329374930",
"telephone_number": "321-777-9559",
"fax_number": "321-777-9558"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MABRY JR",
"first_name": "GEORGE",
"middle_name": "OTTO",
"name_prefix": "Dr.",
"credential": "D.P.M.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-31",
"last_updated": "2016-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "213EP1101X",
"taxonomy_group": "",
"desc": "Podiatrist, Primary Podiatric Medicine",
"state": "FL",
"license": "PO2788",
"primary": true
},
{
"code": "213ER0200X",
"taxonomy_group": "",
"desc": "Podiatrist, Radiology",
"state": "FL",
"license": "JR3863700",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS ID",
"identifier": "65612",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO/QPOS ID #",
"identifier": "2900719",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PPO/POS ID #",
"identifier": "7781081",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "340672500",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA ID #",
"identifier": "0380220001",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indian Harbour Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.