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General NPI Number Information
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NPI Number | 1962439570
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Entity Type | Organization
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Legal Business Name | GORDON PETTY GEORGE, MD, PC
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 800 N 700 W STE 340A
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City | OREM
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State | UT
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Zip | 84057
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Country | US
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Telephone | 801-431-0100
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Fax | 801-431-7354
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Provider Business Mailing Address
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Address Line | 255 S ALPINE DR
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City | ALPINE
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State | UT
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Zip | 84004-1748
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Country | US
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Telephone | 801-431-0100
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Fax | 801-431-7354
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GORDON P GEORGE
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Credential | MD
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Telephone | 801-431-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 166871 1205
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License Number State | UT
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