Organization Active NPI

GGB MD PA

  • Internal Medicine Physician
  • Fort Lauderdale, FL
National Provider Identifier
1679813844
Registry record updated Apr 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME99169 Issued in FL
Legal business name
GGB MD PA
Practice address
935 Intracoastal Dr
Fort Lauderdale, FL 33304-3623
Phone
(954) 776-1180
Fax
(954) 776-1181
NPI assigned
Feb 25, 2013
Last updated
Apr 25, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. George G BoctorNPI 1194925560
Title
Owner
Phone
(954) 776-1180

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME99169 FL Primary

Addresses

Primary practice location

935 Intracoastal Dr
Fort Lauderdale, FL 33304-3623

Mailing address

PO Box 23158
Fort Lauderdale, FL 33307-3158
Phone (954) 776-1180

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130419000185 FL Part B Supplier - Clinic/Group Practice 1456597335 Receives reassigned benefits from 2 practitioners
Practice locations: Fort Lauderdale, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1361750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682380800000",
    "number": "1679813844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23158",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333073158",
            "telephone_number": "954-776-1180",
            "fax_number": "954-776-1181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "935 INTRACOASTAL DR",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333043623",
            "telephone_number": "954-776-1180",
            "fax_number": "954-776-1181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GGB MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-25",
        "last_updated": "2023-04-25",
        "certification_date": "2023-04-25",
        "status": "A",
        "authorized_official_last_name": "BOCTOR",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-776-1180",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME99169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.