Provider Demographics
NPI:1700979853
Name:GEORGE, CAMILLE JACOB (MD)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:JACOB
Last Name:GEORGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4126 SOUTHWEST FWY STE 800
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7216
Mailing Address - Country:US
Mailing Address - Phone:713-572-0030
Mailing Address - Fax:713-572-0040
Practice Address - Street 1:4126 SOUTHWEST FREEWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7316
Practice Address - Country:US
Practice Address - Phone:713-572-0030
Practice Address - Fax:713-572-0040
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4817207XX0005X, 204C00000X, 207XS0106X, 207XS0114X, 207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5470210OtherAETNA
TX80620GOtherBLUE CROSS
TX0373904-01Medicaid
TX80620GOtherBLUE CROSS