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General NPI Number Information
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NPI Number | 1992999544
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Entity Type | Organization
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Legal Business Name | GEORGE L. DELOACH, D.O., PA
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 03/01/2024
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Provider Practice Location Address
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Address Line | 403 OGLETREE DR STE 100
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City | LIVINGSTON
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State | TX
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Zip | 77351-9444
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Country | US
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Telephone | 936-327-9222
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Fax | 936-755-3249
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Provider Business Mailing Address
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Address Line | PO BOX 337
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City | LIVINGSTON
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State | TX
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Zip | 77351-0006
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Country | US
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Telephone | 936-327-9222
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/PRESIDENT
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Name | GEORGE L DELOACH
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Credential | D.O.
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Telephone | 936-755-3238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 4934240001
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | H9881
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License Number State | TX
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