Provider Demographics
NPI:1083662662
Name:GEORGE, RITA M (MD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:M
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:M
Other - Last Name:RICCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:14537 W INDIAN SCHOOL RD
Mailing Address - Street 2:700
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-9243
Mailing Address - Country:US
Mailing Address - Phone:623-935-0247
Mailing Address - Fax:623-935-2209
Practice Address - Street 1:14537 W INDIAN SCHOOL RD
Practice Address - Street 2:700
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-9243
Practice Address - Country:US
Practice Address - Phone:623-935-0247
Practice Address - Fax:623-935-2209
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28297207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2042275OtherUNITED HEALTHCARE
AZ948482Medicaid
AZ188961600OtherDEPT OF LABOR WORK COMP
AZ1083662662OtherBLUE CROSS BLUE SHIELD
AZ7658125OtherAETNA
AZ99S007000001OtherMEDISUN
AZ1467402933OtherPRACTICE NPI
AZ4Z2978OtherHEALTH NET
AZ070014697OtherRAILROAD MEDICARE
AZ948482OtherAHCCCS
AZ1467402933OtherPRACTICE NPI
AZ2042275OtherUNITED HEALTHCARE