Individual
EDWARD EARL ICAZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
(855) 576-4158
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
26567
OK
2084N0400X
Neurology Physician
Primary
K9809
TX
Other
Enumeration date
08/11/2005
Last updated
11/13/2024
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