Provider Demographics
NPI:1548206774
Name:REVERON-QUESTELL, EDMUNDO (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:EDMUNDO
Middle Name:
Last Name:REVERON-QUESTELL
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4335 W PIEDRAS DR
Mailing Address - Street 2:STE 103
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1215
Mailing Address - Country:US
Mailing Address - Phone:210-600-4117
Mailing Address - Fax:210-600-3849
Practice Address - Street 1:4335 W PIEDRAS DR
Practice Address - Street 2:STE 103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1215
Practice Address - Country:US
Practice Address - Phone:210-600-4117
Practice Address - Fax:210-600-3849
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0294207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF99235Medicare UPIN
TX8F9448Medicare PIN