Provider Demographics
NPI:1437488814
Name:GEORGE L GETTY JR MD., PC
Entity Type:Organization
Organization Name:GEORGE L GETTY JR MD., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:LUCIAN
Authorized Official - Last Name:GETTY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:541-474-1854
Mailing Address - Street 1:214 NE OUTLOOK AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1412
Mailing Address - Country:US
Mailing Address - Phone:541-474-1854
Mailing Address - Fax:541-474-1880
Practice Address - Street 1:214 NE OUTLOOK AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1412
Practice Address - Country:US
Practice Address - Phone:541-474-1854
Practice Address - Fax:541-474-1880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13804174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
R0000BHSHMMedicare PIN