Provider Demographics
NPI:1841218328
Name:GEORGE, PAULA Y (MD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:Y
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3691 RUTGER ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2515
Mailing Address - Country:US
Mailing Address - Phone:314-977-5782
Mailing Address - Fax:314-977-1628
Practice Address - Street 1:1201 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1016
Practice Address - Country:US
Practice Address - Phone:314-257-5555
Practice Address - Fax:314-257-5556
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20020267712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
140894000OtherDOL
205998222OtherMO CAID
537465OtherHL
193990OtherMO BLUE
2095276OtherAETNA
25010487OtherMO CARE
4316563150PEOtherMERCY
26632OtherGHP
65276OtherGHP
686OtherB CHOICE
F58916OtherMERCY
140893300OtherDOL
193990OtherB CHOICE
205998214OtherMO CAID
2002026771OtherCHAMPUS
686OtherMO BLUE
6668OtherGHP
872OtherHEALTHCARE US