MEDICARE: ROSHNY A GEORGE 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	207RN0300X	Nephrology Physician	MD60833489	WA
2	207R00000X	Internal Medicine Physician	65057	CO
3	207RN0300X	Nephrology Physician	P0592	TX

General Provider Information

NPI Number	:	1134180268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSHNY A GEORGE MD

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 UNIVERSITY BLVD
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-1053
Country	:	US
Telephone Number	:	512-509-0200
Fax Number	:

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	07/21/2021

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