Healthcare Provider Details

I. General information

NPI: 1346493772
Provider Name (Legal Business Name): EDWARD REQUENEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E RIDGE RD
MCALLEN TX
78503-1847
US

IV. Provider business mailing address

222 E RIDGE RD STE 204
MCALLEN TX
78503-1251
US

V. Phone/Fax

Practice location:
  • Phone: 956-632-6020
  • Fax:
Mailing address:
  • Phone: 956-632-6020
  • Fax: 956-630-6643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberP6900
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberP6900
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: