Provider Demographics
NPI:1669613360
Name:GEORGE, BEN (CO)
Entity type:Individual
Prefix:
First Name:BEN
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 SOUTH UNION
Mailing Address - Street 2:#B-6007
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1806
Mailing Address - Country:US
Mailing Address - Phone:253-383-0094
Mailing Address - Fax:253-383-0669
Practice Address - Street 1:1901 SOUTH UNION AVE
Practice Address - Street 2:#B-6007
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1806
Practice Address - Country:US
Practice Address - Phone:253-383-0094
Practice Address - Fax:253-383-0669
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WACO004897222Z00000X, 225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter