MEDICARE: DR. BRYANT GERARD GEORGE SR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	018940	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083772883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYANT GERARD GEORGE SR. MD

Provider Business Mailing Address
First Line	:	PO BOX 62600
Second Line	:	DEPT 1453
City	:	NEW ORLEANS
State	:	LA
Zip	:	70162-2600
Country	:	US
Telephone Number	:	337-436-7560
Fax Number	:	337-433-9861

Provider Business Practice Location Address
First Line	:	1611 FOSTER ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-5815
Country	:	US
Telephone Number	:	337-436-7560
Fax Number	:	337-433-9861

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	03/05/2009

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