Provider Demographics
NPI:1689821977
Name:GEORGE, TIMOTHY ERVIN JR (US NAVY IDC)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:ERVIN
Last Name:GEORGE
Suffix:JR
Gender:M
Credentials:US NAVY IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS LASSEN (DDG 82)
Mailing Address - Street 2:MEDICAL DEPARTMENT
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96671-1299
Mailing Address - Country:US
Mailing Address - Phone:315-243-3174
Mailing Address - Fax:
Practice Address - Street 1:USS LASSEN
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96671-1299
Practice Address - Country:US
Practice Address - Phone:315-243-3174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman