Provider Demographics
NPI:1225015142
Name:GEORGE, DEBORAH L (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 VIRGIL AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IA
Mailing Address - Zip Code:52314-1589
Mailing Address - Country:US
Mailing Address - Phone:319-895-8841
Mailing Address - Fax:319-895-8477
Practice Address - Street 1:200 VIRGIL AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IA
Practice Address - Zip Code:52314-1589
Practice Address - Country:US
Practice Address - Phone:319-895-8841
Practice Address - Fax:319-895-8477
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22635207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2223289Medicaid
IA3223289Medicaid
IA0223289Medicaid
IA080081138OtherRR MEDICARE
IA1223289Medicaid
IA1225015142Medicaid
IA080081138OtherRR MEDICARE
IA1225015142Medicaid