Provider Demographics
NPI:1588601322
Name:NAZAREWICZ, GEORGE V (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:V
Last Name:NAZAREWICZ
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 1:7400 MERTON MINTER BOULEVARD
Mailing Address - Street 2:MEDICAL STAFF OFFICE 11M, SOUTH TEXAS VETERANS HCS
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4404
Mailing Address - Country:US
Mailing Address - Phone:210-616-8380
Mailing Address - Fax:210-616-8383
Practice Address - Street 1:7400 MERTON MINTER BOULEVARD
Practice Address - Street 2:MEDICAL STAFF OFFICE 11M, SOUTH TEXAS VETERANS HCS
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4404
Practice Address - Country:US
Practice Address - Phone:210-616-8380
Practice Address - Fax:210-616-8383
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME127188207R00000X
TXBP10046894207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP95835Medicare UPIN