Organization
EDWARD E ICAZA MD PA
Active
Other names
Benbrook Neurology
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD EARL ICAZA MD (PRESIDENT)
(817) 615-9496
Entity
Organization
Contact information
Practice address
5801 OAKBEND TRL STE 270, FORT WORTH, TX 76132-3922
(817) 615-9496
(855) 576-4158
Mailing address
5801 OAKBEND TRL STE 270, FORT WORTH, TX 76132-3922
(817) 615-9496
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
K9809
TX
2084N0400X
Neurology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0072JA
BCBS
TX
01
—
K9809
NEUROLOGIST
TX
Enumeration date
10/31/2006
Last updated
11/13/2024
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