Healthcare Provider Details

I. General information

NPI: 1669530697
Provider Name (Legal Business Name): EDMUNDO D YRIGOYEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 W 20TH ST SUITE 708
HOUSTON TX
77008-2441
US

IV. Provider business mailing address

427 W 20TH ST SUITE 708
HOUSTON TX
77008-2441
US

V. Phone/Fax

Practice location:
  • Phone: 713-869-3402
  • Fax: 713-869-9458
Mailing address:
  • Phone: 713-869-3402
  • Fax: 713-869-9458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG2516
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: