Provider Demographics
NPI:1245285345
Name:GEORGE, VIMAL T (MD)
Entity type:Individual
Prefix:DR
First Name:VIMAL
Middle Name:T
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 1:12221 N MOPAC EXPY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2401
Mailing Address - Country:US
Mailing Address - Phone:512-681-5901
Mailing Address - Fax:512-681-5922
Practice Address - Street 1:5145 FM 620 N BLDG I
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732-1839
Practice Address - Country:US
Practice Address - Phone:512-681-5901
Practice Address - Fax:512-681-5922
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1699207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182681002Medicaid
TXI52488Medicare UPIN
TX8G7397Medicare PIN
TX182681002Medicaid
TX182681001Medicaid