Provider Demographics
NPI:1093735078
Name:DELANEY, GEORGE R (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:R
Last Name:DELANEY
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 1:7500 212TH ST SW
Mailing Address - Street 2:SUITE 104
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7641
Mailing Address - Country:US
Mailing Address - Phone:425-582-9617
Mailing Address - Fax:425-582-9686
Practice Address - Street 1:7500 212TH ST SW
Practice Address - Street 2:SUITE 104
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7641
Practice Address - Country:US
Practice Address - Phone:425-582-9617
Practice Address - Fax:425-582-9686
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036707208D00000X
UT3647241205207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870515716018Medicaid
UT870515716004Medicaid
UT870515716018Medicaid
UT870515716004Medicaid
UT107008499101OtherSELECT HEALTH
UT76524OtherPEHP
UTG73008Medicare UPIN
UT870515716004Medicaid