Healthcare Provider Details

I. General information

NPI: 1508420282
Provider Name (Legal Business Name): EDUARDO ANDRES MEJIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2019
Last Update Date: 08/09/2022
Certification Date: 12/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18951 W MEMORIAL DR
HUMBLE TX
77338
US

IV. Provider business mailing address

5911 KATY ST
HOUSTON TX
77007-1053
US

V. Phone/Fax

Practice location:
  • Phone: 281-540-7700
  • Fax:
Mailing address:
  • Phone: 815-900-1887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberT2925
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: