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General NPI Number Information
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NPI Number | 1780640342
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Entity Type | Individual
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Provider Name | P GEORGE JOHN MD
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Gender | Male
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Dates
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Enumeration Date | 04/24/2006
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Last Update Date | 12/19/2013
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Provider Practice Location Address
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Address Line | 1911 N FAIRFIELD RD STE 110A
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City | BEAVERCREEK
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State | OH
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Zip | 45432-2762
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Country | US
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Telephone | 937-429-4826
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Fax | 937-429-4575
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Provider Business Mailing Address
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Address Line | 1911 N FAIRFIELD RD STE 110A
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City | BEAVERCREEK
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State | OH
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Zip | 45432-2762
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Country | US
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Telephone | 937-429-4826
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Fax | 937-429-4575
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35-042936
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License Number State | OH
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