Provider Demographics
NPI:1295953487
Name:ULRICH, EDWARD JOSEPH III (PA-C)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:JOSEPH
Last Name:ULRICH
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S COLORADO ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOCKHART
Mailing Address - State:TX
Mailing Address - Zip Code:78644-2700
Mailing Address - Country:US
Mailing Address - Phone:512-376-9690
Mailing Address - Fax:
Practice Address - Street 1:300 S COLORADO ST
Practice Address - Street 2:SUITE A
Practice Address - City:LOCKHART
Practice Address - State:TX
Practice Address - Zip Code:78644-2700
Practice Address - Country:US
Practice Address - Phone:512-376-9690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05121363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA05121OtherTEXAS STATE PA LICENSE