Provider Demographics
NPI:1124027958
Name:JOHN, GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:JOHN
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 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7920 ELMBROOK DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4933
Practice Address - Country:US
Practice Address - Phone:214-590-2800
Practice Address - Fax:214-590-0865
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2503207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117126607Medicaid
TX117126611Medicaid
TX117126613Medicaid
TX117126614Medicaid
TX117126604Medicaid
TX117126608Medicaid
TX117126606Medicaid
TX117126615Medicaid
TX8P9001OtherBLUE CROSS BLUE SHIELD
TX117126609Medicaid
TX117126610Medicaid
TX117126612Medicaid
TX117126610Medicaid
TXG43136Medicare UPIN