Provider Demographics
NPI:1649556382
Name:GEORGE, JOHN FISHER JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:FISHER
Last Name:GEORGE
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 1:504 TEXAS ST STE 600
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-3529
Mailing Address - Country:US
Mailing Address - Phone:318-681-1031
Mailing Address - Fax:
Practice Address - Street 1:504 TEXAS ST STE 600
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-3529
Practice Address - Country:US
Practice Address - Phone:318-681-1031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022856207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine