Provider Demographics
NPI:1063400943
Name:CYRIAC, GEORGE K (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:K
Last Name:CYRIAC
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 1:201 E MONROE ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-2852
Mailing Address - Country:US
Mailing Address - Phone:573-581-5850
Mailing Address - Fax:573-581-8185
Practice Address - Street 1:620 E MONROE ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-2919
Practice Address - Country:US
Practice Address - Phone:573-581-5850
Practice Address - Fax:573-581-8185
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3A412085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202861704Medicaid
MO300039964OtherMEDICARE RAILROAD
MO202861704Medicaid
MO002011463Medicare PIN