Provider Demographics
NPI:1568592368
Name:GEORGE, JODY ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:ROBERT
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 1:2345 SAMPSON ST
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:LA
Mailing Address - Zip Code:70669-2711
Mailing Address - Country:US
Mailing Address - Phone:337-439-1484
Mailing Address - Fax:337-430-0927
Practice Address - Street 1:2345 SAMPSON ST
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:LA
Practice Address - Zip Code:70669-2711
Practice Address - Country:US
Practice Address - Phone:337-439-1484
Practice Address - Fax:337-430-0927
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA201478207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1073750Medicaid
LA1073750Medicaid