Provider Demographics
NPI:1154306629
Name:COMFORT, GEORGE D (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:D
Last Name:COMFORT
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 1:627 WOODLAWN ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-3148
Mailing Address - Country:US
Mailing Address - Phone:573-581-7685
Mailing Address - Fax:
Practice Address - Street 1:620 E MONROE ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-2919
Practice Address - Country:US
Practice Address - Phone:573-582-4000
Practice Address - Fax:573-582-3712
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO32390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202469805Medicaid
MO323290OtherSTATE OF MISSOURI LICENSE
MO323290OtherSTATE OF MISSOURI LICENSE
MO202469805Medicaid