Provider Demographics
NPI:1912907288
Name:SMALLS, GEORGE D (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:D
Last Name:SMALLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3229 BROADWAY
Mailing Address - Street 2:SUITE 153
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46409-1036
Mailing Address - Country:US
Mailing Address - Phone:219-887-9077
Mailing Address - Fax:219-887-0604
Practice Address - Street 1:3229 BROADWAY
Practice Address - Street 2:SUITE 153
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46409-1036
Practice Address - Country:US
Practice Address - Phone:219-887-9077
Practice Address - Fax:219-887-0604
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01026488208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INB28826Medicare UPIN
IN387440Medicare ID - Type Unspecified