MEDICARE: ELDRIDGE INMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	743288	TX

General Provider Information

NPI Number	:	1861860298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELDRIDGE INMAN

Provider Business Mailing Address
First Line	:	3717 ROYAL MEADOWS ST
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-6869
Country	:	US
Telephone Number	:	281-476-4616
Fax Number	:	281-930-1854

Provider Business Practice Location Address
First Line	:	3717 ROYAL MEADOWS ST
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-6869
Country	:	US
Telephone Number	:	281-476-4616
Fax Number	:	281-930-1854

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2015
Last Update Date	:	09/02/2015

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Directions to “ ELDRIDGE INMAN ” Practice Location

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