Provider Demographics
NPI:1083656078
Name:GEORGE, TIMOTHY KILIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:KILIAN
Last Name:GEORGE
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:301 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5413
Practice Address - Country:US
Practice Address - Phone:432-335-8275
Practice Address - Fax:432-334-0687
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7738207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136959703Medicaid
TX136959701Medicaid
TX8R1595OtherBLUE CROSS OF TEXAS
TX900003012OtherRR MEDICARE
TX136959711Medicaid
NM00033431Medicaid
TX136959704Medicaid
TX136959708OtherCSHCN
TX136959708OtherCSHCN
NM00033431Medicaid
TX8D8767Medicare PIN
TX80W970Medicare PIN