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General NPI Number Information
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NPI Number | 1013272665
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Entity Type | Organization
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Legal Business Name | DR. EDMUND CAVAZOS PLLC
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Dates
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Enumeration Date | 07/10/2012
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Last Update Date | 01/30/2019
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Provider Practice Location Address
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Address Line | 4402 VANCE JACKSON RD STE 100
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City | SAN ANTONIO
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State | TX
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Zip | 78230
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Country | US
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Telephone | 210-688-7735
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Fax | 210-698-7835
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Provider Business Mailing Address
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Address Line | 503 AVENUE A APT 1130
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City | SAN ANTONIO
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State | TX
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Zip | 78215-1272
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Country | US
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Telephone | 270-779-9257
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDMUND CAVAZOS III
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Credential | M.D.
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Telephone | 512-551-2949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | J5084
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License Number State | TX
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