Provider Demographics
NPI:1275730707
Name:SAM T GEORGE, PA
Entity Type:Organization
Organization Name:SAM T GEORGE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:THOYAKULATHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-640-1422
Mailing Address - Street 1:1211 E 6TH ST
Mailing Address - Street 2:STE 300
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-4095
Mailing Address - Country:US
Mailing Address - Phone:903-640-1422
Mailing Address - Fax:903-640-4275
Practice Address - Street 1:1211 E 6TH ST
Practice Address - Street 2:STE 300
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-4095
Practice Address - Country:US
Practice Address - Phone:903-640-1422
Practice Address - Fax:903-640-4275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5496207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00858NMedicare ID - Type Unspecified
TXF86780Medicare UPIN