Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | C8288 | TX |
Y | 111NI0900X | Internist | C8288 | TX |
N | 207RG0300X | Geriatric Medicine | C8288 | TX |
NPI | 1144229659 |
---|---|
Provider Name | Dr. William Dewitt George JR. |
First Address | Beaumont, TX 77702-1845 |
Second Address | Nederland, TX 77627-6249 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 11/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
133790915 | (05) | TX |
8CU673 | BCBS (01) | TX |
C16044 | (02) | TX |