Basic Information
| Provider Information | |||||||||
| NPI: | 1609860618 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEORGE | ||||||||
| FirstName: | MANJU | ||||||||
| MiddleName: | BABU | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2410 HARBOR PASS DR | ||||||||
| Address2: | |||||||||
| City: | PEARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775843428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8322596875 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1917 W GRAY ST | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770194801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8322600650 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2005 | ||||||||
| LastUpdateDate: | 09/26/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | L9613 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | L9613 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 179197203 | 05 | TX | MEDICAID | 1609860618 | 01 | TX | BCBSTX | OTHER | 179197202 | 05 | TX | MEDICAID | 8V1564 | 01 | TX | BCBS TX | OTHER | 1609860618 | 01 | TX | TRICARE SOUTH | OTHER |