Provider Demographics
NPI:1982648424
Name:GEORGE, SATHIYARAJ (MD)
Entity Type:Individual
Prefix:
First Name:SATHIYARAJ
Middle Name:
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 1:1616 E GRIFFIN PKWY
Mailing Address - Street 2:PMB 158
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3180
Mailing Address - Country:US
Mailing Address - Phone:956-583-7393
Mailing Address - Fax:956-583-7309
Practice Address - Street 1:2121 E GRIFFIN PKWY
Practice Address - Street 2:STE 10
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3241
Practice Address - Country:US
Practice Address - Phone:956-583-7393
Practice Address - Fax:956-583-7309
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4433207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0021KZOtherBCBS IND PROVIDER #
TX00212WOtherMEDICARE UPIN UPDATE
TX144575102Medicaid
TX00212WOtherMEDICARE UPIN UPDATE
TX0021KZOtherBCBS IND PROVIDER #