Provider Demographics
NPI:1851396055
Name:POGSON, GEORGE WILLIAM III (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:WILLIAM
Last Name:POGSON
Suffix:III
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 1:19550 E 39TH ST S
Mailing Address - Street 2:SUITE 220
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2303
Mailing Address - Country:US
Mailing Address - Phone:816-461-6837
Mailing Address - Fax:816-833-1760
Practice Address - Street 1:19550 E 39TH ST S
Practice Address - Street 2:SUITE 220
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2303
Practice Address - Country:US
Practice Address - Phone:816-461-6837
Practice Address - Fax:816-833-1760
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7233207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200887834Medicaid
MOJ384023Medicare ID - Type Unspecified
MO200887834Medicaid