Healthcare Provider Details

I. General information

NPI: 1740398643
Provider Name (Legal Business Name): JOSEPH C GEORGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 11/12/2022
Certification Date: 11/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 S LEMAY AVE
FORT COLLINS CO
80524-3929
US

IV. Provider business mailing address

2008 CARIBOU DR
FORT COLLINS CO
80525-4325
US

V. Phone/Fax

Practice location:
  • Phone: 970-495-7000
  • Fax:
Mailing address:
  • Phone: 970-484-4757
  • Fax: 970-484-4759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01040751A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number34862
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number14675C
License Number StateWY
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberCDRH.0068990
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: