Healthcare Provider Details

I. General information

NPI: 1336438878
Provider Name (Legal Business Name): ERIC LEE MADARANG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4254 S ALAMEDA ST
CORPUS CHRISTI TX
78412
US

IV. Provider business mailing address

917 S PORT AVE
CORPUS CHRISTI TX
78405-2301
US

V. Phone/Fax

Practice location:
  • Phone: 361-500-4351
  • Fax: 888-711-1008
Mailing address:
  • Phone: 361-883-1879
  • Fax: 361-883-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN8811
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberN8811
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: