Provider Demographics
NPI:1982020780
Name:EDGARDO G ADVINCULA MD PA
Entity Type:Organization
Organization Name:EDGARDO G ADVINCULA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDD
Authorized Official - Middle Name:
Authorized Official - Last Name:ADVINCULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-759-2226
Mailing Address - Street 1:PO BOX 687
Mailing Address - Street 2:
Mailing Address - City:MUENSTER
Mailing Address - State:TX
Mailing Address - Zip Code:76252-0687
Mailing Address - Country:US
Mailing Address - Phone:940-759-2226
Mailing Address - Fax:940-759-2385
Practice Address - Street 1:509 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:MUENSTER
Practice Address - State:TX
Practice Address - Zip Code:76252-2425
Practice Address - Country:US
Practice Address - Phone:940-759-2226
Practice Address - Fax:940-759-2385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5812207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty