Provider Demographics
NPI:1609817774
Name:TARRYK, GEORGE H (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:H
Last Name:TARRYK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 LONG BEACH BLVD
Mailing Address - Street 2:465
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1531
Mailing Address - Country:US
Mailing Address - Phone:562-989-5844
Mailing Address - Fax:562-989-5846
Practice Address - Street 1:2840 LONG BEACH BLVD
Practice Address - Street 2:465
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1531
Practice Address - Country:US
Practice Address - Phone:562-989-5844
Practice Address - Fax:562-989-5846
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG14655207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G146550Medicaid
CA00G146550Medicaid
CAG14655Medicare ID - Type Unspecified