| Doctor Name: | DR. GEORGE OTTO MABRY JR |
| NPI Number: | 1023079688 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.P.M. |
| License Number: | 12-000307 |
| Business Practice Address: | 2194 Hwy A1a Suite 108 Indian Harbour Beach, FL - 329374930 |
| Business Phone Number: | 3217779559 |
| Business Fax Number: | 3217779558 |
| Mailing Address: | 2194 Hwy A1a, Suite 108 INDIAN HARBOUR BEACH |
| State: | FL |
| Postal Code: | 329374930 |
| Phone Number: | 3217779559 |
| Fax Number: | 3217779558 |
| NPI Enumeration Date: | 03/31/2006 |
| NPI Last Update Date: | 03/14/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213EP1101X |
| License Number: | 12-000307 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | KS |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Primary Podiatric Medicine |
| Taxonomy Definition: | |