Provider Demographics
NPI:1225089105
Name:EDMUNDSON, HERBERT P JR (MD, PHD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:P
Last Name:EDMUNDSON
Suffix:JR
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7777 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 900
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1802
Mailing Address - Country:US
Mailing Address - Phone:713-981-9971
Mailing Address - Fax:713-981-1457
Practice Address - Street 1:7777 SOUTHWEST FWY
Practice Address - Street 2:SUITE 900
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1802
Practice Address - Country:US
Practice Address - Phone:713-981-9971
Practice Address - Fax:713-981-1457
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG80912084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4105221OtherAETNA
TX130010537OtherRAILROAD MEDICARE
TX10014684OtherAMERIGROUP
TX119018302Medicaid
TXMDG8091OtherW/C
TX29055OtherTEXAN PLUS
ED0871313OtherBCBS OUT OF STATE
TX375890300OtherDEPT OF LABOR
TX871313OtherBLUE CROSS BLUE SHIELD
TX4105221OtherAETNA
TX375890300OtherDEPT OF LABOR