Provider Demographics
NPI:1588668578
Name:TOMANENG, EDWARD U (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:U
Last Name:TOMANENG
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 1:2000C MEDICAL PKWY
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666
Mailing Address - Country:US
Mailing Address - Phone:512-353-8899
Mailing Address - Fax:512-353-8311
Practice Address - Street 1:2000C MEDICAL PARKWAY
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666
Practice Address - Country:US
Practice Address - Phone:512-353-8899
Practice Address - Fax:512-353-8311
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7897174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110610601Medicaid
TX110610601Medicaid
TX00GF84Medicare PIN