MEDICARE: GEORGE KOOMOS

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	174400000X	Specialist	E2260	TX
2	207L00000X	Anesthesiology Physician	E2260	TX

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	:	1114998291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE KOOMOS

Provider Business Mailing Address
First Line	:	4444 CORONA DR
Second Line	:	SUITE 215
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78411-4324
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4444 CORONA DR
Second Line	:	SUITE 215
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78411-4324
Country	:	US
Telephone Number	:	361-985-1221
Fax Number	:

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

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	03/19/2009

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Directions to “ GEORGE KOOMOS ” Practice Location

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