Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | J4817 | TX |
Y | 207X00000X | Orthopaedic Surgeon | J4817 | TX |
N | 207XS0106X | Orthopaedic Hand Surgeon | J4817 | TX |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | J4817 | TX |
N | 207XS0117X | Orthopaedic Spine Surgeon | J4817 | TX |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | J4817 | TX |
NPI | 1700979853 |
---|---|
Provider Name | Camille Jacob George |
First Address | Houston, TX 77027-7216 |
Second Address | Houston, TX 77027-7316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 16/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0373904-01 | (05) | TX |
5470210 | AETNA (01) | TX |
80620G | BLUE CROSS (01) | TX |
G31710 | (02) | TX |