Provider Demographics
NPI:1477540227
Name:GEORGE, SANTOSH (MD)
Entity Type:Individual
Prefix:DR
First Name:SANTOSH
Middle Name:
Last Name:GEORGE
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 1:2609 GLENN HENDREN DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-3313
Mailing Address - Country:US
Mailing Address - Phone:816-407-4555
Mailing Address - Fax:816-407-2362
Practice Address - Street 1:2521 GLENN HENDREN DR
Practice Address - Street 2:SUITE 204
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-3388
Practice Address - Country:US
Practice Address - Phone:816-781-6066
Practice Address - Fax:816-792-5130
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002010575207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0388010001OtherDMERC
MO475B755OtherMEDICARE PTAN
MO205864507Medicaid
MO205864507Medicaid