Provider Demographics
NPI:1811066251
Name:SOLOMON, GEORGE DAVID III (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:DAVID
Last Name:SOLOMON
Suffix:III
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 1:1204 SUTTON DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-8306
Mailing Address - Country:US
Mailing Address - Phone:573-874-1151
Mailing Address - Fax:
Practice Address - Street 1:1204 SUTTON DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-8306
Practice Address - Country:US
Practice Address - Phone:573-874-1151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36819207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA12614Medicare UPIN