Healthcare Provider Details

I. General information

NPI: 1578637567
Provider Name (Legal Business Name): GEORGE PRICA JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 E BROADWAY STE 110
COLUMBIA MO
65201-8023
US

IV. Provider business mailing address

1605 E BROADWAY STE 110
COLUMBIA MO
65201-8023
US

V. Phone/Fax

Practice location:
  • Phone: 573-815-8130
  • Fax: 573-815-8149
Mailing address:
  • Phone: 573-815-8130
  • Fax: 573-815-8149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMDR9140
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberMDR9140
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: