Provider Demographics
NPI:1023007432
Name:EDMOND, JANE COVINGTON (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:COVINGTON
Last Name:EDMOND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4771
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4771
Mailing Address - Country:US
Mailing Address - Phone:832-822-3230
Mailing Address - Fax:713-796-8110
Practice Address - Street 1:6621 FANNIN ST
Practice Address - Street 2:MCCC 640.00
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2303
Practice Address - Country:US
Practice Address - Phone:832-822-3230
Practice Address - Fax:832-825-4776
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0326207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82W287OtherBC/BS
TX137830903Medicaid
TX3252145OtherBLUE LINK
TX137830911Medicaid
TX137830903Medicaid
TX82W287OtherBC/BS
TX3252145OtherBLUE LINK
TXP00278222Medicare PIN
TX8L0843Medicare PIN
TX82W287Medicare PIN