Provider Demographics
NPI:1619288230
Name:GEORGE, JIM (MD)
Entity type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:GEORGE
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 1:763 E US HIGHWAY 80
Mailing Address - Street 2:SUITE 240
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-8633
Mailing Address - Country:US
Mailing Address - Phone:469-689-0100
Mailing Address - Fax:
Practice Address - Street 1:763 E US HIGHWAY 80
Practice Address - Street 2:SUITE 240
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-8633
Practice Address - Country:US
Practice Address - Phone:469-689-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3722207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP3722OtherTX LIC