Individual
DR. JOHN EDEEN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4499 MEDICAL DR, SUITE 235, SAN ANTONIO, TX 78229-3735
(210) 692-1613
(210) 616-0290
Mailing address
4499 MEDICAL DRIVE, SUITE 235, SAN ANTONIO, TX 78229-3712
(210) 692-1613
(210) 616-0290
Taxonomy
Speciality
Code
Description
License number
State
207XP3100X
Pediatric Orthopaedic Surgery Physician
Primary
K3719
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
048514602
TPI
TX
05
—
048514602
—
TX
Enumeration date
02/17/2006
Last updated
08/22/2011
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