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Individual

DR. EDWIN CONCERMAN EMBORGO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1023 N MOUND ST, SUITE A, NACOGDOCHES, TX 75961-4491
(936) 564-2691
(713) 634-2636
Mailing address
PO BOX 630696, NACOGDOCHES, TX 75963-0696
(936) 564-2691
(713) 634-2636

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
E4705
AR
207Q00000X
Family Medicine Physician
Primary
M8458
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
203713701
TX
01
M8458
PHYSICIAN LICENSE
TX
Enumeration date
06/03/2006
Last updated
03/18/2011
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