Provider Demographics
NPI:1992999544
Name:GEORGE L. DELOACH, D.O., PA
Entity type:Organization
Organization Name:GEORGE L. DELOACH, D.O., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DELOACH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:936-755-3238
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-0006
Mailing Address - Country:US
Mailing Address - Phone:936-327-9222
Mailing Address - Fax:
Practice Address - Street 1:403 OGLETREE DR STE 100
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-9444
Practice Address - Country:US
Practice Address - Phone:936-327-9222
Practice Address - Fax:936-755-3249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9881207X00000X
TX4934240001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0048QSOtherBLUE CROSS BLUE SHEILD
DG4922OtherMEDICARE RR/PALMETTO GBA
TX154512101Medicaid
TX00159TMedicare PIN
TX154512101Medicaid