Provider Demographics
NPI:1134180268
Name:GEORGE, ROSHNY A (MD)
Entity type:Individual
Prefix:
First Name:ROSHNY
Middle Name:A
Last Name:GEORGE
Suffix:
Gender:F
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:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:425 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1053
Practice Address - Country:US
Practice Address - Phone:512-509-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60833489207RN0300X
CO65057207R00000X
TXP0592207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO20338OtherBCBS
AR161505001Medicaid
MO208331009Medicaid
MO200474OtherBCBS
431560263OtherTRICARE WEST
P00708681OtherRAILROAD MEDICARE - SJC
MOP00297078OtherRR MEDICARE
MOP00342325OtherRAIL ROAD MEDICARE
MOI47563Medicare UPIN
MO208331009Medicaid