Provider Demographics
NPI:1700833415
Name:CALVERT, GEORGE T (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:T
Last Name:CALVERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-272-5063
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:210 E GRAY ST
Practice Address - Street 2:STE.604
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3900
Practice Address - Country:US
Practice Address - Phone:502-629-5633
Practice Address - Fax:502-629-5580
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2005028545207X00000X
KY48974207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO938932295Medicare ID - Type Unspecified