Provider Demographics
NPI:1215575568
Name:VALDEZ, EDWIN IVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:IVAN
Last Name:VALDEZ
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 1:19500 IH 10 W STOP 2-4090
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-9509
Mailing Address - Country:US
Mailing Address - Phone:210-762-3662
Mailing Address - Fax:
Practice Address - Street 1:6907 N CAPITAL OF TEXAS HWY STE 240
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1710
Practice Address - Country:US
Practice Address - Phone:915-540-5172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXU3680208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program