Provider Demographics
NPI:1699783670
Name:JIRAK, GEORGE VICTOR (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:VICTOR
Last Name:JIRAK
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 1:2000 EOFF ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3823
Mailing Address - Country:US
Mailing Address - Phone:304-234-8663
Mailing Address - Fax:304-234-1877
Practice Address - Street 1:2115 CHAPLINE ST
Practice Address - Street 2:SUITE 206
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3859
Practice Address - Country:US
Practice Address - Phone:304-232-9000
Practice Address - Fax:304-234-8360
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20617207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2273221Medicaid
160053934OtherRAILROAD MEDICARE
WV2000460000Medicaid
WV2000460000Medicaid
160053934OtherRAILROAD MEDICARE