Individual
EDDY R VIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1004 WINSCOTT RD, BENBROOK, TX 76126-2776
(817) 249-0111
Mailing address
1004 WINSCOTT RD, BENBROOK, TX 76126-2776
(817) 249-0111
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
J6045
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136868011
—
TX
Enumeration date
09/13/2005
Last updated
02/23/2022
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