Provider Demographics
NPI:1780698738
Name:GEORGE, MUTTAVANCHERIL JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:MUTTAVANCHERIL
Middle Name:JOSEPH
Last Name:GEORGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4205 SALTBURN DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3151
Mailing Address - Country:US
Mailing Address - Phone:972-867-0132
Mailing Address - Fax:903-583-6709
Practice Address - Street 1:1201 E 9TH ST
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-4059
Practice Address - Country:US
Practice Address - Phone:903-583-6727
Practice Address - Fax:903-583-6709
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK3202207R00000X
NY186631207R00000X
NJ56697207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine