Provider Demographics
NPI:1265531370
Name:EMMANUEL EDOKA, M.D.
Entity type:Organization
Organization Name:EMMANUEL EDOKA, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:EDOKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-322-0800
Mailing Address - Street 1:805 E 32ND STREET
Mailing Address - Street 2:STE 103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2537
Mailing Address - Country:US
Mailing Address - Phone:512-322-0800
Mailing Address - Fax:512-322-0827
Practice Address - Street 1:805 E 32ND STREET
Practice Address - Street 2:STE 103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2537
Practice Address - Country:US
Practice Address - Phone:512-322-0800
Practice Address - Fax:512-322-0827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162610301Medicaid
TX00541UMedicare PIN