Provider Demographics
NPI:1356335855
Name:MONCADA, EDGAR E (MD)
Entity type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:E
Last Name:MONCADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:100 E ALTON GLOOR BLVD
Mailing Address - Street 2:BLDG. B STE 260
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-3328
Mailing Address - Country:US
Mailing Address - Phone:956-350-3901
Mailing Address - Fax:956-350-3900
Practice Address - Street 1:100 E ALTON GLOOR BLVD
Practice Address - Street 2:BLDG. B STE 260
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-3328
Practice Address - Country:US
Practice Address - Phone:956-350-3901
Practice Address - Fax:956-350-3900
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7487208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164543402Medicaid
TXI03057Medicare UPIN
TX8D2142Medicare PIN
P00332064Medicare PIN