Provider Demographics
NPI:1821280629
Name:GEORGE, ALISTER A (MD)
Entity Type:Individual
Prefix:MR
First Name:ALISTER
Middle Name:A
Last Name:GEORGE
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 1:3510 N. MOORPARK RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360
Mailing Address - Country:US
Mailing Address - Phone:805-492-4800
Mailing Address - Fax:805-492-4880
Practice Address - Street 1:3510 N. MOORPARK RD
Practice Address - Street 2:SUITE 201
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360
Practice Address - Country:US
Practice Address - Phone:805-492-4800
Practice Address - Fax:805-492-4880
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63795174400000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF43112Medicare UPIN