Provider Demographics
NPI:1386641413
Name:GEORGE, LARRY E (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:E
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 1:265 TANGLEWOOD LANE
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:SILVERTHORNE
Mailing Address - State:CO
Mailing Address - Zip Code:80498
Mailing Address - Country:US
Mailing Address - Phone:970-468-1003
Mailing Address - Fax:
Practice Address - Street 1:265 TANGLEWOOD DRIVE
Practice Address - Street 2:STE. E-1
Practice Address - City:SILVERTHORNE
Practice Address - State:CO
Practice Address - Zip Code:80498
Practice Address - Country:US
Practice Address - Phone:970-468-1003
Practice Address - Fax:970-262-2196
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38133207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07027044Medicaid
D87604Medicare UPIN
269328Medicare PIN