Healthcare Provider Details

I. General information

NPI: 1235565862
Provider Name (Legal Business Name): TONY GEORGE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2013
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 AIRPORT RD STE L103
TEMPLE TX
76502-7092
US

IV. Provider business mailing address

PO BOX 844658
DALLAS TX
75284-4658
US

V. Phone/Fax

Practice location:
  • Phone: 254-724-2585
  • Fax: 254-724-1747
Mailing address:
  • Phone: 800-994-0371
  • Fax: 254-215-9722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA08463
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: