Provider Demographics
NPI:1295948594
Name:BACKARDJIEV, GEORGE TODOROV (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:TODOROV
Last Name:BACKARDJIEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GEORGI
Other - Middle Name:TODOROV
Other - Last Name:BAKARDJIEV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3141 SABA LN
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-5421
Mailing Address - Country:US
Mailing Address - Phone:409-722-9995
Mailing Address - Fax:409-539-6095
Practice Address - Street 1:3141 SABA LN
Practice Address - Street 2:
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651-5421
Practice Address - Country:US
Practice Address - Phone:409-722-9995
Practice Address - Fax:409-539-6095
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-115001207VG0400X, 207VX0000X, 207V00000X
TXN4270207VG0400X, 207VX0000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1194047084Medicaid
TX1295948594Medicaid