Provider Demographics
NPI:1417277518
Name:ARDEEL, ERIC RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:RAYMOND
Last Name:ARDEEL
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 1:1140 BUSINESS CENTER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-2744
Mailing Address - Country:US
Mailing Address - Phone:713-932-5757
Mailing Address - Fax:713-932-5750
Practice Address - Street 1:9250 PINECROFT DRIVE
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3218
Practice Address - Country:US
Practice Address - Phone:713-798-0190
Practice Address - Fax:281-364-2535
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3113207P00000X
TXBP10037422282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBP10037422OtherPIT PERMIT