Provider Demographics
NPI:1265576516
Name:GEORGE, DARREN KEITH (DO)
Entity type:Individual
Prefix:
First Name:DARREN
Middle Name:KEITH
Last Name:GEORGE
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 1:1050 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-2905
Mailing Address - Country:US
Mailing Address - Phone:573-364-9000
Mailing Address - Fax:
Practice Address - Street 1:1000 GW LN
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-2339
Practice Address - Country:US
Practice Address - Phone:573-774-2715
Practice Address - Fax:573-202-2410
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5768207Q00000X
MTMED-PHYS-LIC-120488207Q00000X
MO2024029857207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128588402Medicaid
TX8410K0Medicare ID - Type Unspecified
TX128588402Medicaid