Individual
GEORGE THOMAS WATERFALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
323 WEST WALNUT, BASTROP, LA 71220
(800) 893-9698
Mailing address
200 CORPORATE BLVD, STE 201, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
014605
LA
208D00000X
General Practice Physician
Primary
MD.014605
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1345598
—
LA
Enumeration date
07/10/2006
Last updated
01/14/2025
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