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General NPI Number Information
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NPI Number | 1912941196
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Entity Type | Individual
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Provider Name | RICHARD L GEORGE MD
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Gender | Male
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 11141 PARKVIEW PLAZA DR STE 305
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City | FORT WAYNE
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State | IN
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Zip | 46845-1715
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Country | US
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Telephone | 260-266-8900
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Fax | 260-266-8935
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Provider Business Mailing Address
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Address Line | 11109 PARKVIEW PLAZA DR # 117
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City | FORT WAYNE
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State | IN
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Zip | 46845-1701
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Country | US
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Telephone |
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Fax |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 22388
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 35.094071
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 01094175A
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License Number State | IN
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