Provider Demographics
NPI:1396745790
Name:VAN DEN SIGTENHORST, GEORG DIRK (MD)
Entity type:Individual
Prefix:
First Name:GEORG
Middle Name:DIRK
Last Name:VAN DEN SIGTENHORST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DIRK
Other - Middle Name:
Other - Last Name:SIGTENHORST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:605 E SAN ANTONIO ST
Mailing Address - Street 2:SUITE 510E
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-6050
Mailing Address - Country:US
Mailing Address - Phone:361-572-4750
Mailing Address - Fax:361-485-0932
Practice Address - Street 1:605 E SAN ANTONIO ST
Practice Address - Street 2:510 E
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6040
Practice Address - Country:US
Practice Address - Phone:361-572-4750
Practice Address - Fax:361-485-0932
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4761208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BE224OtherBLUE CROSS BLUE SHIELD OF TX
TX043392201Medicaid
TX043392201Medicaid
TX8BE224OtherBLUE CROSS BLUE SHIELD OF TX
TXF77444Medicare UPIN