Provider Demographics
NPI:1033117767
Name:SANMIGUEL, GEORGE (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:SANMIGUEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W HAGUE RD
Mailing Address - Street 2:260
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5814
Mailing Address - Country:US
Mailing Address - Phone:915-225-3822
Mailing Address - Fax:915-225-3832
Practice Address - Street 1:125 W HAGUE RD
Practice Address - Street 2:260
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5814
Practice Address - Country:US
Practice Address - Phone:915-225-3822
Practice Address - Fax:915-225-3832
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1968207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122695305Medicaid
TX00508UOtherMEDICARE GROUP PIN
TXD87480Medicare UPIN
TX122695305Medicaid