Provider Demographics
NPI:1003038043
Name:DUCKWORTH, EDWARD A M (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:A M
Last Name:DUCKWORTH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1709 DRYDEN RD
Mailing Address - Street 2:SUITE 750 - DEPARTMENT OF NEUROSURGERY
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2400
Mailing Address - Country:US
Mailing Address - Phone:713-798-4946
Mailing Address - Fax:713-798-3739
Practice Address - Street 1:1709 DRYDEN RD
Practice Address - Street 2:SUITE 750 - DEPARTMENT OF NEUROSURGERY
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2400
Practice Address - Country:US
Practice Address - Phone:713-798-4946
Practice Address - Fax:713-798-3739
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036116403207T00000X
TXN2478207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L14740Medicare PIN
TX8L14492Medicare PIN