Provider Demographics
NPI: | 1710991906 |
---|---|
Name: | GEORGE, ANNA K (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | ANNA |
Middle Name: | K |
Last Name: | GEORGE |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | ANIA |
Other - Middle Name: | |
Other - Last Name: | KUJAWSKA |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | MD |
Mailing Address - Street 1: | PO BOX 202110 |
Mailing Address - Street 2: | |
Mailing Address - City: | AUSTIN |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78720-2110 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 512-732-2774 |
Mailing Address - Fax: | 855-959-1863 |
Practice Address - Street 1: | 5656 BEE CAVES RD |
Practice Address - Street 2: | |
Practice Address - City: | WEST LAKE HILLS |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78746-5280 |
Practice Address - Country: | US |
Practice Address - Phone: | 512-732-2774 |
Practice Address - Fax: | 512-331-5192 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-07-27 |
Last Update Date: | 2017-05-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | Q0260 | 207K00000X |
AZ | 35827 | 208000000X |
CO | 47635 | 207K00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CO | 39051013 | Medicaid | |
CO | CO305158 | Medicare PIN | |
CO | 39051013 | Medicaid |