Provider Demographics
NPI:1780640342
Name:JOHN, P GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:P
Middle Name:GEORGE
Last Name:JOHN
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 1:1911 N FAIRFIELD RD
Mailing Address - Street 2:STE 110A
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2762
Mailing Address - Country:US
Mailing Address - Phone:937-429-4826
Mailing Address - Fax:937-429-4575
Practice Address - Street 1:1911 N FAIRFIELD RD
Practice Address - Street 2:STE 110A
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2762
Practice Address - Country:US
Practice Address - Phone:937-429-4826
Practice Address - Fax:937-429-4575
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-042936208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0388334Medicaid
OH0457887Medicare PIN
OH0388334Medicaid
H008520Medicare PIN