Provider Demographics
NPI:1346665338
Name:GEORGE KOSTOHRYZ, JR., M.D., P.A.
Entity Type:Organization
Organization Name:GEORGE KOSTOHRYZ, JR., M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSTOHRYZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:817-346-6464
Mailing Address - Street 1:4625 BOAT CLUB RD STE 257
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-7023
Mailing Address - Country:US
Mailing Address - Phone:817-346-6464
Mailing Address - Fax:817-238-2358
Practice Address - Street 1:4625 BOAT CLUB RD STE 257
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-7023
Practice Address - Country:US
Practice Address - Phone:817-346-6464
Practice Address - Fax:817-238-2358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8642207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty