Provider Demographics
NPI:1235319906
Name:BOLLOZOS, GEORGE DADO (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:DADO
Last Name:BOLLOZOS
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 1:2040 CONCOURSE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4119
Mailing Address - Country:US
Mailing Address - Phone:314-872-7149
Mailing Address - Fax:314-872-7155
Practice Address - Street 1:2040 CONCOURSE DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4119
Practice Address - Country:US
Practice Address - Phone:314-872-7149
Practice Address - Fax:314-872-7155
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO33057291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory