Provider Demographics
NPI:1295766228
Name:EDUARDO O CAVEDA MD PA
Entity type:Organization
Organization Name:EDUARDO O CAVEDA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:OTTO
Authorized Official - Last Name:CAVEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-384-0909
Mailing Address - Street 1:110 ARMSTRONG STREET
Mailing Address - Street 2:BOX 1290
Mailing Address - City:ORANGE GROVE
Mailing Address - State:TX
Mailing Address - Zip Code:78372
Mailing Address - Country:US
Mailing Address - Phone:361-384-0909
Mailing Address - Fax:361-384-9998
Practice Address - Street 1:110 ARMSTRONG STREET
Practice Address - Street 2:BOX 1290
Practice Address - City:ORANGE GROVE
Practice Address - State:TX
Practice Address - Zip Code:78372
Practice Address - Country:US
Practice Address - Phone:361-384-0909
Practice Address - Fax:361-384-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4017261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148743101Medicaid
TX153997501Medicaid
TX148743101Medicaid
TX153997501Medicaid