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General NPI Number Information
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NPI Number | 1326034901
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Entity Type | Individual
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Provider Name | GEORGE ROBERT JOHN MD
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Gender | Male
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6400 DUTCHMANS PKWY STE 220 A
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City | LOUISVILLE
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State | KY
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Zip | 40205-3340
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Country | US
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Telephone | 502-894-9757
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Fax | 502-894-9257
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Provider Business Mailing Address
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Address Line | 6400 DUTCHMANS PKWY STE 220A
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City | LOUISVILLE
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State | KY
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Zip | 40205-3343
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Country | US
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Telephone | 502-894-9757
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Fax | 502-894-9257
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 01044404
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 29119
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License Number State | KY
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