Provider Demographics
NPI:1679687164
Name:CLOUD, GEORGE J JR (OPA-C)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:J
Last Name:CLOUD
Suffix:JR
Gender:M
Credentials:OPA-C
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Mailing Address - Street 1:6850 CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1653
Mailing Address - Country:US
Mailing Address - Phone:708-429-3455
Mailing Address - Fax:708-429-3422
Practice Address - Street 1:6850 CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1653
Practice Address - Country:US
Practice Address - Phone:708-429-3455
Practice Address - Fax:708-429-3422
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2008-07-24
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01620925OtherBCBS