Provider Demographics
NPI:1649687922
Name:EDEMEKONG, PETER F (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:F
Last Name:EDEMEKONG
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Gender:M
Credentials:MD, MPH
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Mailing Address - Street 1:PO BOX 650859
Mailing Address - Street 2:DEPT 710
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265
Mailing Address - Country:US
Mailing Address - Phone:409-772-2222
Mailing Address - Fax:979-864-3054
Practice Address - Street 1:146 E HOSPITAL DR STE 205
Practice Address - Street 2:UTMB HEALTH PEDIATRIC AND ADULT PRIMARY CARE - ANGLETON
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-4171
Practice Address - Country:US
Practice Address - Phone:979-864-3034
Practice Address - Fax:979-864-3054
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2023-02-23
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Provider Licenses
StateLicense IDTaxonomies
TX46672207Q00000X
NE7159207Q00000X
FLME130847207QA0505X
TXT1689207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine