Provider Demographics
NPI:1821028655
Name:EDRALIN, JOSEPH PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PATRICK
Last Name:EDRALIN
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 1:4800 W PANTHER CREEK DR
Mailing Address - Street 2:STE 100
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-2563
Mailing Address - Country:US
Mailing Address - Phone:281-364-8600
Mailing Address - Fax:281-298-2005
Practice Address - Street 1:4800 W PANTHER CREEK DR
Practice Address - Street 2:STE 100
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-2563
Practice Address - Country:US
Practice Address - Phone:281-364-8600
Practice Address - Fax:281-298-2005
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1454208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF59515Medicare UPIN