Provider Demographics
NPI:1033156658
Name:HARIZ, GEORGE M (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:M
Last Name:HARIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 N GALLOWAY AVE STE 221
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2491
Mailing Address - Country:US
Mailing Address - Phone:972-270-7500
Mailing Address - Fax:972-289-5900
Practice Address - Street 1:929 N GALLOWAY AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2476
Practice Address - Country:US
Practice Address - Phone:972-270-7500
Practice Address - Fax:972-289-5900
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH58972086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034130701Medicaid
TX020020220OtherRAILROAD MEDICARE
TX00J99QOtherBLUE SHIELD
TX020020220OtherRAILROAD MEDICARE
TX00J99QMedicare PIN