Provider Demographics
NPI: | 1669472544 |
---|---|
Name: | ASSI, EDWARD RALPH (DO) |
Entity Type: | Individual |
Prefix: | MR |
First Name: | EDWARD |
Middle Name: | RALPH |
Last Name: | ASSI |
Suffix: | |
Gender: | M |
Credentials: | DO |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1700 CLIFF, BLDG A |
Mailing Address - Street 2: | SUITE 200 |
Mailing Address - City: | EL PASO |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 79902 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 915-577-9009 |
Mailing Address - Fax: | 915-577-9006 |
Practice Address - Street 1: | 1700 CLIFF, BLDG A |
Practice Address - Street 2: | SUITE 200 |
Practice Address - City: | EL PASO |
Practice Address - State: | TX |
Practice Address - Zip Code: | 79902 |
Practice Address - Country: | US |
Practice Address - Phone: | 915-577-9009 |
Practice Address - Fax: | 915-577-9006 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2005-07-21 |
Last Update Date: | 2012-12-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | K5782 | 207RC0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 1446858-07 | Medicaid | |
TX | P00060917 | Other | MEDICARE RAILROAD |
TX | 8K0980 | Other | BLUE CROSS BLUE SHIELD |
TX | P00060917 | Other | MEDICARE RAILROAD |
8A9001 | Medicare PIN |