Basic Information
| Provider Information | |||||||||
| NPI: | 1700052123 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MYO | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | K. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2161 E PECOS RD STE 1 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852256131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027532663 | ||||||||
| FaxNumber: | 4802472479 | ||||||||
| Practice Location | |||||||||
| Address1: | 2161 E PECOS RD STE 1 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852256131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027532663 | ||||||||
| FaxNumber: | 4802472479 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2008 | ||||||||
| LastUpdateDate: | 08/11/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 42034 | AZ | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XP3100X | 42034 | AZ | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Pediatric Orthopaedic Surgery | 207XS0106X | 42034 | AZ | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | 207XS0114X | 42034 | AZ | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | 207XX0004X | 42034 | AZ | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | 207XX0801X | 42034 | AZ | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma |
No ID Information.