Healthcare Provider Details

I. General information

NPI: 1346728656
Provider Name (Legal Business Name): EHIZOGIE EDIGIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2306 RAYFORD RD
SPRING TX
77386-1707
US

IV. Provider business mailing address

12812 HEDDINGTON GROVE LN
HOUSTON TX
77047-2230
US

V. Phone/Fax

Practice location:
  • Phone: 872-817-0144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberT7913
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberT7913
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: