Provider Demographics
NPI:1194827691
Name:GEORGE, ANTHONY D (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:D
Last Name:GEORGE
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 1:900 ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-3114
Mailing Address - Country:US
Mailing Address - Phone:715-342-7633
Mailing Address - Fax:715-343-3206
Practice Address - Street 1:900 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-3114
Practice Address - Country:US
Practice Address - Phone:715-342-7633
Practice Address - Fax:715-343-3206
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39886207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39886OtherSTATE LICENSE #
WI110168056OtherRR MEDICARE PROV #
WI32456600Medicaid
WI36444OtherNETWORK HEALTH PROV #
WI1019240001OtherUHC MA DIAMOND PROV #
WID04564Medicare UPIN
WI0041Medicare ID - Type UnspecifiedMEDICARE SEQUENCE #