Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | G3388 | TX |
NPI | 1043261597 |
---|---|
Provider Name | Richard E George |
First Address | Lubbock, TX 79424-7374 |
Second Address | Lubbock, TX 79424-7374 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 10/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
139707711 | (05) | TX |
84820F | BCBS (01) | TX |
E13730 | (02) | TX |