Provider Demographics
NPI:1467563908
Name:KOHL, EDWARD ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ALAN
Last Name:KOHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4499 MEDICAL DR
Mailing Address - Street 2:SUITE 245
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3735
Mailing Address - Country:US
Mailing Address - Phone:210-616-0789
Mailing Address - Fax:210-692-1930
Practice Address - Street 1:4499 MEDICAL DR
Practice Address - Street 2:SUITE 245
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3735
Practice Address - Country:US
Practice Address - Phone:210-616-0789
Practice Address - Fax:210-692-1930
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE3721207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00PF34OtherBLUE CROSS-BLUE SHIELD
B24054Medicare UPIN
TX00PF34Medicare PIN