Provider Demographics
NPI:1639109291
Name:MANLONGAT, GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:MANLONGAT
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 1:920 MEDICAL PLAZA DR
Mailing Address - Street 2:140
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3260
Mailing Address - Country:US
Mailing Address - Phone:281-359-1190
Mailing Address - Fax:281-359-1540
Practice Address - Street 1:22999 HIGHWAY 59 N
Practice Address - Street 2:194
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77339-4438
Practice Address - Country:US
Practice Address - Phone:281-359-1190
Practice Address - Fax:281-359-1540
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ8655207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG25059Medicare UPIN
TX8593B0Medicare ID - Type UnspecifiedPROVIDER NUMBER