Provider Demographics
NPI:1447597554
Name:KOENIG, GEORGE HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:HENRY
Last Name:KOENIG
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 1:79963 RANCHO LA QUINTA DR
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-6330
Mailing Address - Country:US
Mailing Address - Phone:760-771-4141
Mailing Address - Fax:760-771-4443
Practice Address - Street 1:79963 RANCHO LA QUINTA DR
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-6330
Practice Address - Country:US
Practice Address - Phone:760-771-4141
Practice Address - Fax:760-771-4443
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAFE19817207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAFE19817OtherCALIFORNIA MEDICAL LICENSE NUMBER