MEDICARE: BIJO GEORGE

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	363LF0000X	Family Nurse Practitioner	AP125961	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP125961	OTHER	TX	TEXAS BOARD OF NURSING

General Provider Information

NPI Number	:	1821404831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIJO GEORGE

Provider Business Mailing Address
First Line	:	4630 SAWMILL LN
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77505-5526
Country	:	US
Telephone Number	:	832-763-1036
Fax Number	:

Provider Business Practice Location Address
First Line	:	6807 EMMETT F LOWRY EXPY STE 310
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-2548
Country	:	US
Telephone Number	:	409-908-9345
Fax Number	:

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

Provider Enumeration Date	:	07/10/2014
Last Update Date	:	07/10/2014

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Directions to “ BIJO GEORGE ” Practice Location

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