MEDICARE: EMMANUEL EDOKA, M.D.

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	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265531370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMMANUEL EDOKA, M.D.

Provider Business Mailing Address
First Line	:	805 E 32ND STREET
Second Line	:	STE 103
City	:	AUSTIN
State	:	TX
Zip	:	78705-2537
Country	:	US
Telephone Number	:	512-322-0800
Fax Number	:	512-322-0827

Provider Business Practice Location Address
First Line	:	805 E 32ND STREET
Second Line	:	STE 103
City	:	AUSTIN
State	:	TX
Zip	:	78705-2537
Country	:	US
Telephone Number	:	512-322-0800
Fax Number	:	512-322-0827

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	EMMANUEL C EDOKA
Credential	:	MD
Telephone Number	:	512-322-0800

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	04/17/2008

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