Provider Demographics
NPI:1174865786
Name:GEORGE, ANAMARI LACARRA (MD)
Entity Type:Individual
Prefix:
First Name:ANAMARI
Middle Name:LACARRA
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANAMARI
Other - Middle Name:PILAR
Other - Last Name:LACARRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 844273
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-593-1892
Mailing Address - Fax:
Practice Address - Street 1:214 E HOUSTON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8131
Practice Address - Country:US
Practice Address - Phone:903-593-1892
Practice Address - Fax:903-533-1747
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXQ6833208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX363685401Medicaid
TXP01721577OtherRAIL ROAD MEDICARE
TX8GC558OtherBCBS
TX8GC558OtherBCBS