Provider Demographics
NPI:1548207988
Name:GEORGE, DONALD L (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:L
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 1:4700 POINT FOSDICK DR NW
Mailing Address - Street 2:STE 203-A
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1706
Mailing Address - Country:US
Mailing Address - Phone:253-857-1120
Mailing Address - Fax:253-857-1121
Practice Address - Street 1:4700 POINT FOSDICK DR NW
Practice Address - Street 2:STE 203-A
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1706
Practice Address - Country:US
Practice Address - Phone:253-857-1120
Practice Address - Fax:253-857-1121
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024466174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA020007512OtherRAILROAD MEDICARE
WA01326OtherL&I
WA0248294OtherSTATE L&I
WA0248300OtherSTATE L&I
WA0257524OtherSTATE L&I
WA1029941Medicaid
WA01326OtherL&I
WA0248300OtherSTATE L&I
G8881424Medicare PIN
WA020007512OtherRAILROAD MEDICARE