Healthcare Provider Details

I. General information

NPI: 1336143296
Provider Name (Legal Business Name): GEORGE M AUSTIN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 NW MOCK AVE STE 200
BLUE SPRINGS MO
64014-2530
US

IV. Provider business mailing address

206 NW MOCK AVE STE 200
BLUE SPRINGS MO
64014-2530
US

V. Phone/Fax

Practice location:
  • Phone: 816-224-8999
  • Fax: 816-224-3121
Mailing address:
  • Phone: 816-224-8999
  • Fax: 816-224-3121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberR8754
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: