Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | H0326 | TX |
NPI | 1023007432 |
---|---|
Provider Name | Jane Covington Edmond |
First Address | Houston, TX 77210-4771 |
Second Address | Houston, TX 77030-2303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2005 |
Last Update Date | 30/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
137830903 | (05) | TX |
137830911 | (05) | TX |
3252145 | BLUE LINK (01) | TX |
82W287 | BC/BS (01) | TX |
E52145 | (02) |