Provider Demographics
NPI:1144268939
Name:CARGILL, JOHN GEORGE III (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GEORGE
Last Name:CARGILL
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:1 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4500
Practice Address - Country:US
Practice Address - Phone:828-253-5314
Practice Address - Fax:828-254-5216
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC33002208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4369651OtherAETNA
NC890515HMedicaid
NCP00996853OtherRAILROAD MEDICARE
NC1168229OtherGATEWAY HEALTH
NC4369651OtherAETNA
NCNC2864AMedicare PIN
VAB08209Medicare UPIN
NCP00996853OtherRAILROAD MEDICARE
NC2038199Medicare PIN
VAC08143Medicare PIN