MEDICARE: EDGAR BEDOLLA 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	208600000X	Surgery Physician	27188	OK
2	2086S0122X	Plastic and Reconstructive Surgery Physician	R7662	TX
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1265691158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDGAR BEDOLLA MD

Provider Business Mailing Address
First Line	:	7777 FOREST LN STE C818
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-7526
Country	:	US
Telephone Number	:	214-271-6308
Fax Number	:

Provider Business Practice Location Address
First Line	:	7777 FOREST LN STE C818
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-7526
Country	:	US
Telephone Number	:	214-271-6308
Fax Number	:

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

Provider Enumeration Date	:	06/05/2008
Last Update Date	:	01/12/2026

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Directions to “ EDGAR BEDOLLA MD” Practice Location

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