George R Kiracofe, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

22645 Issued in AL

Practice address

80 B Veterans Blvd
I-40, Exit 102
Acoma, NM 87034

Phone

(505) 552-5300

Fax

(505) 552-5828

NPI assigned

Jul 17, 2006

Last updated

May 26, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432598400000",
    "number": "1033137443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "SAN FIDEL",
            "state": "NM",
            "postal_code": "870490130",
            "telephone_number": "505-552-5300",
            "fax_number": "505-552-5828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 B VETERANS BLVD",
            "address_2": "I-40, EXIT 102",
            "city": "ACOMA",
            "state": "NM",
            "postal_code": "87034",
            "telephone_number": "505-552-5300",
            "fax_number": "505-552-5828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRACOFE",
        "first_name": "GEORGE",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2015-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "22645",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "H3451",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jason J. Johnson
• Angela Kao, PHARM.D.
• Richard M Kaut, MD
• Earl S Kimbell III, DO
• Emily King, PSY.D.
• Lonnie Lewis
• Esther Lorenzo
• Amanda Lucario
• Yvonne Lutter, PSY.D.
• Steadman A Mason, MD

• Family Medicine Physician in Acoma, NM
• Providers in Acoma, NM by specialty
• Family Medicine Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.