Provider Demographics
NPI:1942288451
Name:DELOACH, GEORGE L (DO)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:L
Last Name:DELOACH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-0006
Mailing Address - Country:US
Mailing Address - Phone:936-327-9222
Mailing Address - Fax:936-327-9220
Practice Address - Street 1:403 OGLETREE DR STE 100
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-9444
Practice Address - Country:US
Practice Address - Phone:936-755-3238
Practice Address - Fax:936-755-3249
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9881207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035937402Medicaid
TX8AJ864OtherBLUE CROSS BLUE SHEILD
200035071OtherMEDICARE RR/PALMETTO GBA
200035071OtherMEDICARE RR/PALMETTO GBA
TX8349B0Medicare PIN