Healthcare Provider Details

I. General information

NPI: 1467427435
Provider Name (Legal Business Name): CECIL R GEORGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

387 W IH 10
FORT STOCKTON TX
79735-2700
US

IV. Provider business mailing address

387 W IH 10
FORT STOCKTON TX
79735-2700
US

V. Phone/Fax

Practice location:
  • Phone: 432-336-2058
  • Fax: 844-315-7399
Mailing address:
  • Phone: 432-336-2058
  • Fax: 844-315-7399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF6658
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: