Provider Demographics
NPI:1336143296
Name:AUSTIN, GEORGE M (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:M
Last Name:AUSTIN
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 1:206 NW MOCK AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2530
Mailing Address - Country:US
Mailing Address - Phone:816-224-8999
Mailing Address - Fax:816-224-3121
Practice Address - Street 1:206 NW MOCK AVE
Practice Address - Street 2:STE 200
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2530
Practice Address - Country:US
Practice Address - Phone:816-224-8999
Practice Address - Fax:816-224-3121
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8754174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO07414054OtherBLUE CROSS BLUE SHIELD
MO340004705OtherRAILROAD MEDICARE
MO07414054OtherBLUE CROSS BLUE SHIELD
MOH823938Medicare ID - Type Unspecified