Provider Demographics
NPI:1285610592
Name:GETTY, GEORGE LUCIAN (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:LUCIAN
Last Name:GETTY
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 1:214 NE OUTLOOK AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1412
Mailing Address - Country:US
Mailing Address - Phone:541-474-1854
Mailing Address - Fax:541-474-1880
Practice Address - Street 1:214 NE OUTLOOK AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1412
Practice Address - Country:US
Practice Address - Phone:541-474-1854
Practice Address - Fax:541-474-1880
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13804208800000X
CAA31537208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR291658Medicaid
OR0000BHSHMMedicare ID - Type Unspecified
OR291658Medicaid