Provider Demographics
NPI:1578637567
Name:PRICA, GEORGE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:PRICA
Suffix:JR
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 1:1605 E BROADWAY STE 110
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8023
Mailing Address - Country:US
Mailing Address - Phone:573-815-8130
Mailing Address - Fax:573-815-8149
Practice Address - Street 1:1605 E BROADWAY STE 110
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8023
Practice Address - Country:US
Practice Address - Phone:573-815-8130
Practice Address - Fax:573-815-8149
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR9140207Q00000X, 2084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
0209064OtherUNITED HEALTH CARE
4369470OtherAETNA
122799OtherHEALTHLINK
MO200999407Medicaid
22575OtherBLUE CROSS BLUE SHIELD
50801OtherGROUP HEALTH PLANS
4369470OtherAETNA
MO004011255Medicare ID - Type Unspecified