Provider Demographics
NPI:1598825697
Name:BEDELL, ERIC A (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:A
Last Name:BEDELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ERIC
Other - Middle Name:A
Other - Last Name:BEDELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2411 FOUNTAIN VIEW DR
Mailing Address - Street 2:STE. 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-4817
Mailing Address - Country:US
Mailing Address - Phone:713-620-4000
Mailing Address - Fax:
Practice Address - Street 1:2411 FOUNTAIN VIEW DR
Practice Address - Street 2:STE. 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-4817
Practice Address - Country:US
Practice Address - Phone:713-620-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7997207L00000X
AL28134207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009943193Medicaid
MS02577504Medicaid
AL009943194Medicaid
AL051541245OtherBLUE CROSS
AL051541246OtherBLUE CROSS
TX8AT554OtherBLUE CROSS BLUE SHIELD
AL009943196Medicaid
AL009943197Medicaid
AL051541244OtherBLUE CROSS
TX117258701Medicaid
AL051541243OtherBLUE CROSS
TX117258704Medicaid
TXP00697089OtherRAILROAD MEDICARE
TX8AT554OtherBLUE CROSS BLUE SHIELD
AL051541244OtherBLUE CROSS
AL009943197Medicaid
AL009943196Medicaid
TX8L7398Medicare PIN