Provider Demographics
NPI:1104831833
Name:PJURA, GEORGE A (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:A
Last Name:PJURA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:70 DOCTORS PARK
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-4928
Mailing Address - Country:US
Mailing Address - Phone:573-334-6071
Mailing Address - Fax:573-334-4739
Practice Address - Street 1:70 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4928
Practice Address - Country:US
Practice Address - Phone:573-334-6071
Practice Address - Fax:573-334-4739
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1096982085N0904X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO185214OtherMO BLUE CROSS BLUE SHIELD
430954380OtherMERCY HEALTH PLAN
063896OtherHEALTH ALLIANCE
AR143795001Medicaid
IL036-097949OtherIL BLUE CROSS BLUE SHIELD
289890OtherHEALTHLINK
MO208270306Medicaid
AR143795001Medicaid
MO014010086Medicare ID - Type UnspecifiedMO MEDICARE
MO185214OtherMO BLUE CROSS BLUE SHIELD
IL036-097949OtherIL BLUE CROSS BLUE SHIELD
430954380OtherMERCY HEALTH PLAN