1144229659 NPI number — DR. WILLIAM DEWITT GEORGE JR. M.D.

Table of content: LOUANNE STRICKLAND MFT (NPI 1972643310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144229659 NPI number — DR. WILLIAM DEWITT GEORGE JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEORGE
Provider First Name:
WILLIAM
Provider Middle Name:
DEWITT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144229659
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/18/2006
NPI Reactivation Date:
03/29/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2929 CALDER ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BEAUMONT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77702-1845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-833-9797
Provider Business Mailing Address Fax Number:
409-654-6886

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 HIGHWAY 365
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
NEDERLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77627-6249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-833-9797
Provider Business Practice Location Address Fax Number:
409-654-6816
Provider Enumeration Date:
07/18/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  C8288 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0300X , with the licence number: C8288 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: C8288 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 133790915 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8CU673 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".