Provider Demographics
NPI:1619933181
Name:GEORGE, JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
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 1:224 ORANGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-5127
Mailing Address - Country:US
Mailing Address - Phone:337-948-2188
Mailing Address - Fax:337-981-1308
Practice Address - Street 1:3501 HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-5129
Practice Address - Country:US
Practice Address - Phone:337-580-7900
Practice Address - Fax:337-580-7902
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024923207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1420832Medicaid
P00244775OtherRAILROAD MEDICARE
LA4E088CR05Medicare PIN
P00244775OtherRAILROAD MEDICARE
LA4E404CN95Medicare ID - Type Unspecified
4E404Medicare ID - Type Unspecified
LA1420832Medicaid
LAH56355Medicare UPIN
4E088Medicare ID - Type Unspecified