Individual
EVERTON ANTHONY EDMONDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6560 FANNIN ST, SUITE 1234, HOUSTON, TX 77030-2761
(713) 797-1180
(713) 797-0641
Mailing address
6560 FANNIN ST, SUITE 1234, HOUSTON, TX 77030-2761
(713) 797-1180
(713) 797-0641
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
G9451
TX
208VP0014X
Interventional Pain Medicine Physician
G9451
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
139241712
—
TX
05
—
139241716
—
TX
05
—
139241717
—
TX
01
—
8AJ445
BLUE CROSS
TX
Enumeration date
01/03/2006
Last updated
11/13/2020
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