Provider Demographics
NPI:1053571794
Name:GEORGOLIOS, ALEXANDROS (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDROS
Middle Name:
Last Name:GEORGOLIOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 VENIZELOU STREET
Mailing Address - Street 2:
Mailing Address - City:HOLARGOS
Mailing Address - State:ATTIKI
Mailing Address - Zip Code:15561
Mailing Address - Country:GR
Mailing Address - Phone:01210-654-5443
Mailing Address - Fax:
Practice Address - Street 1:3100 OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-1573
Practice Address - Country:US
Practice Address - Phone:573-778-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP526207Y00000X
MO2013045551207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology