Provider Information for 1023233236
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Dr. GEORGE R NORTHRUP Ph.D.
Other Names:Other Name:Dr. RANDY NORTHRUPSex: Male
NPI: 1023233236
Last Updated: 2024-08-07
Certification Date: 2024-08-07
Certification Date: 2024-08-07
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1023233236 | ||||||||
| Enumeration Date | 2007-04-13 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 112 WARBLER WAY STE 324 SHAVANO PARK, TX 78231-1448 United States Phone: 626-376-7708 | Fax:626-793-7607 | ||||||||
| Primary Practice Address | 112 WARBLER WAY STE 324 SHAVANO PARK, TX 78231-1448 United States Phone: 626-376-7708 | Fax:626-793-7607 | ||||||||
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