Individual
DR. GEORGE J VETTIANKAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
209 GASLIGHT BLVD, LUFKIN, TX 75904-3134
(936) 632-8787
(713) 798-4693
Mailing address
310 GASLIGHT BLVD, LUFKIN, TX 75904-3133
(936) 632-8787
(713) 798-4693
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
37151
KY
207RC0000X
Cardiovascular Disease Physician
Primary
S2190
TX
207RI0011X
Interventional Cardiology Physician
37151
KY
207RI0011X
Interventional Cardiology Physician
S2190
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64050446
—
KY
01
—
P00316516
RAIL ROAD MEDICARE PIN
KY
Enumeration date
11/10/2005
Last updated
08/13/2025
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