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General NPI Number Information
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NPI Number | 1932263241
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Entity Type | Organization
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Legal Business Name | MARY K. GEORGE, M.D., P.A.
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 11/05/2007
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Provider Practice Location Address
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Address Line | 9179 GRISSOM RD SUITE 135
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City | SAN ANTONIO
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State | TX
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Zip | 78251-2809
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Country | US
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Telephone | 210-684-1020
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Fax | 210-684-2434
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Provider Business Mailing Address
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Address Line | 9179 GRISSOM RD SUITE 135
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City | SAN ANTONIO
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State | TX
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Zip | 78251-2809
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Country | US
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Telephone | 210-684-1020
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Fax | 210-684-2434
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARY KUSUM GEORGE
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Credential | M.D.
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Telephone | 210-684-1020
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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 | E5084
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License Number State | TX
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