Provider Demographics
NPI:1558375634
Name:GEORGE, JOSH OOMMEN (MD)
Entity Type:Individual
Prefix:
First Name:JOSH
Middle Name:OOMMEN
Last Name:GEORGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 35629
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-0629
Mailing Address - Country:US
Mailing Address - Phone:214-424-2200
Mailing Address - Fax:214-231-2159
Practice Address - Street 1:900 W MAGNOLIA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-8517
Practice Address - Country:US
Practice Address - Phone:817-870-7300
Practice Address - Fax:817-335-9529
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2017-02-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL3973207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8GF968OtherBLUE CROSS BLUE SHIELD
TX544874YPGSMedicare PIN
BG9769766OtherDEA