Provider Demographics
NPI:1932263241
Name:MARY K. GEORGE, M.D., P.A.
Entity Type:Organization
Organization Name:MARY K. GEORGE, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KUSUM
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-684-1020
Mailing Address - Street 1:9179 GRISSOM RD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-2809
Mailing Address - Country:US
Mailing Address - Phone:210-684-1020
Mailing Address - Fax:210-684-2434
Practice Address - Street 1:9179 GRISSOM RD
Practice Address - Street 2:SUITE 135
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-2809
Practice Address - Country:US
Practice Address - Phone:210-684-1020
Practice Address - Fax:210-684-2434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5084208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty