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Organization
EDWARD C. JUAREZ, MD, PA
Active
Organization
EDWARD C. JUAREZ, MD, PA
Active
Other names
Eastside Medical Care Center, PA
Organization subpart
No
Provider details
NPI number
Authorized official
LAURENCE JUAREZ (ADMINISTRATOR)
(915) 842-0504
Entity
Organization
Contact information
Practice address
1721 N LEE TREVINO DR, EL PASO, TX 79936-4521
(915) 590-9424
(915) 590-9049
Mailing address
PO BOX 12520, EL PASO, TX 79913-0520
(915) 842-0504
(915) 842-0448
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0858375-01
—
TX
01
—
CD3874
PALMETTO GBA
TX
05
—
L0399
—
NM
Enumeration date
12/28/2005
Last updated
12/19/2012
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