Provider Demographics
NPI:1376854968
Name:CANOVA, EDUARDO CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:CARLOS
Last Name:CANOVA
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 1:6602 POLARIS DR
Mailing Address - Street 2:STE 5
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041
Mailing Address - Country:US
Mailing Address - Phone:973-405-1115
Mailing Address - Fax:956-791-6814
Practice Address - Street 1:801 N US HIGHWAY 83
Practice Address - Street 2:
Practice Address - City:ZAPATA
Practice Address - State:TX
Practice Address - Zip Code:78076-3290
Practice Address - Country:US
Practice Address - Phone:956-765-8494
Practice Address - Fax:956-765-8297
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX286902602Medicaid
TX286902602Medicaid