Basic Information
| Provider Information | |||||||||
| NPI: | 1104232115 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABDELMESSIEH | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5300 E ERICKSON DR STE 118 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857122809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203266766 | ||||||||
| FaxNumber: | 5207401939 | ||||||||
| Practice Location | |||||||||
| Address1: | 5300 E ERICKSON DR STE 118 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857122809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203266766 | ||||||||
| FaxNumber: | 5207401939 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2014 | ||||||||
| LastUpdateDate: | 01/16/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 874 | AZ | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213ES0103X | 0116027575 | VA | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 341544 | 05 | AZ | MEDICAID |