Organization
EC PA
Active
Other names
Sculpt
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDDIE L CERDAY M.D. (M.D./ PRESIDENT)
(210) 495-0086
Entity
Organization
Contact information
Practice address
540 MADISON OAK STE 140, SAN ANTONIO, TX 78258-3919
(210) 495-0086
(210) 495-0801
Mailing address
540 MADISON OAK STE 140, SAN ANTONIO, TX 78258-3919
(210) 495-0086
(210) 495-0801
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
5019
TX
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
F9289
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477525533
NPI
TX
01
—
5019
STATE LICENSE
TX
05
—
603040
—
TX
01
—
F9289
STATE LICENSE
TN
Enumeration date
12/02/2010
Last updated
12/02/2010
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