Provider Demographics
NPI:1669530697
Name:YRIGOYEN, EDMUNDO D (MD)
Entity type:Individual
Prefix:
First Name:EDMUNDO
Middle Name:D
Last Name:YRIGOYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 W 20TH ST
Mailing Address - Street 2:SUITE 708
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-2441
Mailing Address - Country:US
Mailing Address - Phone:713-869-3402
Mailing Address - Fax:713-869-9458
Practice Address - Street 1:427 W 20TH ST
Practice Address - Street 2:SUITE 708
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-2441
Practice Address - Country:US
Practice Address - Phone:713-869-3402
Practice Address - Fax:713-869-9458
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2516207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX76-0252348OtherTAX IDENTIFICATION
TX1000887-01Medicaid
TXB27753Medicare UPIN
TX1000887-01Medicaid