Provider Demographics
NPI:1154498855
Name:MIGUEL, EDILBERTO R (MD)
Entity Type:Individual
Prefix:DR
First Name:EDILBERTO
Middle Name:R
Last Name:MIGUEL
Suffix:
Gender:M
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 558
Mailing Address - Street 2:317 E 2ND STREET
Mailing Address - City:DUMAS
Mailing Address - State:TX
Mailing Address - Zip Code:79029
Mailing Address - Country:US
Mailing Address - Phone:806-935-9194
Mailing Address - Fax:806-935-7261
Practice Address - Street 1:317 E 2ND STREET
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:TX
Practice Address - Zip Code:79029
Practice Address - Country:US
Practice Address - Phone:806-935-9194
Practice Address - Fax:806-935-7261
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1116207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035380701Medicaid
TX00PR07Medicare ID - Type Unspecified
TX035380701Medicaid