Healthcare Provider Details

I. General information

NPI: 1891955944
Provider Name (Legal Business Name): EDWARD C. NWANEGBO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E RIDGE RD
MCALLEN TX
78503
US

IV. Provider business mailing address

7500 RIALTO BLVD STE 1-140
AUSTIN TX
78735-8534
US

V. Phone/Fax

Practice location:
  • Phone: 512-730-3056
  • Fax: 888-730-1925
Mailing address:
  • Phone: 512-730-3056
  • Fax: 888-730-1925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301099056
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR-8307
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberP20906
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP2906
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: