MEDICARE: EDWARD EARL ICAZA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	26567	OK
2	2084N0400X	Neurology Physician	K9809	TX

General Provider Information

NPI Number	:	1134121940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD EARL ICAZA MD

Provider Business Mailing Address
First Line	:	5801 OAKBEND TRL STE 270
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3922
Country	:	US
Telephone Number	:	817-615-9496
Fax Number	:	855-576-4158

Provider Business Practice Location Address
First Line	:	5801 OAKBEND TRL STE 270
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3922
Country	:	US
Telephone Number	:	817-615-9496
Fax Number	:	855-576-4158

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	11/13/2024

Similar Medicare Providers

1033295142 — EDWARD E ICAZA MD PA
Practice Location Address:

5801 OAKBEND TRL STE 270
FORT WORTH, TX
76132-3922

Practice Phone: 817-615-9496
Practice Fax: 855-576-4158

1235369695 — SATISH CHANDRAPRAKASAM M.D.
Practice Location Address:

5801 OAKBEND TRL STE 270
FORT WORTH, TX
76132-3922

Practice Phone: 817-882-6868
Practice Fax: 817-439-9115

1295685162 — MADISON LENOW PA
Practice Location Address:

2800 CHERRY LN
FORT WORTH, TX
76116-3922

Practice Phone: 817-702-2977
Practice Fax: 817-702-2140

1306098108 — SHERI LYNN WHITE-HACKLEY PT
Practice Location Address:

31740 CEDAR ST
FORT BRAGG, CA
95437-3922

Practice Phone: 707-961-1606
Practice Fax:

1346563327 — DR. IRINA PIKOVSKAYA PHARMD
Practice Location Address:

640 FORT WASHINGTON AVE APT 3G
NEW YORK, NY
10040-3922

Practice Phone: 347-907-9633
Practice Fax:

1336409192 — BLUE WATER MEDICAL PLLC
Practice Location Address:

511 FORT ST , SUITE 102
PORT HURON, MI
48060-3922

Practice Phone: 810-479-4769
Practice Fax: 888-414-4545

Directions to “ EDWARD EARL ICAZA MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.