Individual
DR. EDMUND CAVAZOS III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4242 MEDICAL DR STE 6300, SAN ANTONIO, TX 78229-5606
(210) 614-8400
(210) 614-8165
Mailing address
PO BOX 897, BOWLING GREEN, KY 42102-0897
(270) 783-4070
(270) 783-4070
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
30639
KY
2084P0800X
Psychiatry Physician
Primary
J5084
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64306392
—
KY
Enumeration date
07/18/2005
Last updated
02/06/2019
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