Provider Demographics
NPI:1831230242
Name:GEORGE, DARRYL BRETT (DO)
Entity type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:BRETT
Last Name:GEORGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1224 NE WALNUT ST # 255
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-2026
Mailing Address - Country:US
Mailing Address - Phone:541-440-1934
Mailing Address - Fax:541-440-1943
Practice Address - Street 1:455 W COREY CT
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3078
Practice Address - Country:US
Practice Address - Phone:541-440-1934
Practice Address - Fax:541-440-1943
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORDO22049207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine