1225015142 NPI number — DEBORAH L GEORGE MD

Table of content: DEBORAH L GEORGE MD (NPI 1225015142)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225015142 NPI number — DEBORAH L GEORGE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEORGE
Provider First Name:
DEBORAH
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1225015142
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 VIRGIL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT VERNON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52314-1589
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-895-8841
Provider Business Mailing Address Fax Number:
319-895-8477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 VIRGIL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52314-1589
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-895-8841
Provider Business Practice Location Address Fax Number:
319-895-8477
Provider Enumeration Date:
12/30/2005

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: 207Q00000X , with the licence number:  22635 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2223289 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3223289 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0223289 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080081138 . This is a "RR MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 1223289 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1225015142 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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