Provider Demographics
NPI:1679562326
Name:GEORGE, P A (MD)
Entity Type:Individual
Prefix:
First Name:P
Middle Name:A
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 1:2516 PALOMINO DR
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-1894
Mailing Address - Country:US
Mailing Address - Phone:573-332-1829
Mailing Address - Fax:
Practice Address - Street 1:2516 PALOMINO DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-1894
Practice Address - Country:US
Practice Address - Phone:573-332-1829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013002188207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7932OtherBCBS
MO201239407Medicaid
A11262Medicare UPIN
000004759Medicare ID - Type Unspecified
0430013OtherUNITED HEALTHCARE