Individual
DR. ERIC S MADORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 510-1186
Mailing address
PO BOX 5500, TYLER, TX 75712-5500
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
L8117
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164585502
—
TX
01
—
8J1055
BCBS
TX
01
—
TIN PLUS 042
TRICARE
TX
Enumeration date
02/15/2006
Last updated
05/12/2014
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