Provider Demographics
NPI:1669450185
Name:CANALES, EDMUNDO C (MD)
Entity Type:Individual
Prefix:DR
First Name:EDMUNDO
Middle Name:C
Last Name:CANALES
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 3744
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-3744
Mailing Address - Country:US
Mailing Address - Phone:956-682-4151
Mailing Address - Fax:956-682-4154
Practice Address - Street 1:1305 E NOLANA ST
Practice Address - Street 2:SUITE A
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6114
Practice Address - Country:US
Practice Address - Phone:956-682-4151
Practice Address - Fax:956-682-4154
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4889207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8V1950OtherBCBS
TXP00391771OtherMEDICARE RAILROAD
TX134595109Medicaid
TX134595109Medicaid
TX8F2815Medicare PIN