MEDICARE: DR. DAVID EIDELSON 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	208VP0014X	Interventional Pain Medicine Physician	S7042	TX

General Provider Information

NPI Number	:	1609296987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID EIDELSON M.D.

Provider Business Mailing Address
First Line	:	1228 CREEKSIDE ACRES CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1473
Country	:	US
Telephone Number	:	561-213-7580
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 W SAM HOUSTON PKWY N STE 110
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-1236
Country	:	US
Telephone Number	:	713-996-0900
Fax Number	:	713-500-6270

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

Provider Enumeration Date	:	04/24/2014
Last Update Date	:	01/26/2023

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