Provider Demographics
NPI:1700886264
Name:BAKATSAS, GEORGE CHRIS (DPM)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:CHRIS
Last Name:BAKATSAS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:CHRIS
Other - Last Name:BAKATSAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:WOLFFORTH
Mailing Address - State:TX
Mailing Address - Zip Code:79382-0098
Mailing Address - Country:US
Mailing Address - Phone:806-300-0134
Mailing Address - Fax:806-300-0851
Practice Address - Street 1:6849 82ND STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424
Practice Address - Country:US
Practice Address - Phone:806-300-0134
Practice Address - Fax:806-300-0851
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2018-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1316213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092745101Medicaid
TX0077AWMedicare PIN
U54406Medicare UPIN