MEDICARE: DR. EDWARD A. COONEY 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	207Q00000X	Family Medicine Physician	H1752	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	82466K	OTHER	TX	BLUE SHIELD

General Provider Information

NPI Number	:	1568422400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD A. COONEY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:	254-724-8800
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 N HEWITT DR
Second Line	:
City	:	HEWITT
State	:	TX
Zip	:	76643-3038
Country	:	US
Telephone Number	:	254-666-3666
Fax Number	:

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	02/16/2022

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Directions to “ DR. EDWARD A. COONEY M.D.” Practice Location

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