Provider Demographics
NPI:1639102064
Name:HESITA, EDSEL LUMBIS (MD)
Entity Type:Individual
Prefix:
First Name:EDSEL
Middle Name:LUMBIS
Last Name:HESITA
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:11130 CHRISTUS HLS STE 210
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-3586
Practice Address - Country:US
Practice Address - Phone:210-245-2000
Practice Address - Fax:210-245-2020
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4152207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7633831OtherAETNA HMO
TX7633831OtherAETNA PPO
TXP01547615OtherRAILROAD MEDICARE
TX8S2186OtherBLUECROSS/BLUESHIELD TX.
TX182238902Medicaid
TX8S2186OtherBLUECROSS/BLUESHIELD TX.
TX182238902Medicaid
TXP00369965Medicare PIN
TX8G8461Medicare PIN
TX436852YKYCMedicare PIN