Provider Demographics
NPI:1154539757
Name:XAVIER, EDWARD S (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:S
Last Name:XAVIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 130894
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77393-0894
Mailing Address - Country:US
Mailing Address - Phone:936-321-0033
Mailing Address - Fax:936-321-0032
Practice Address - Street 1:111 VISION PARK BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3002
Practice Address - Country:US
Practice Address - Phone:936-321-0033
Practice Address - Fax:936-321-0032
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3395207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX209252002Medicaid
TX209252001Medicaid
TX209252001Medicaid
TX8L19012Medicare UPIN
TXP00781870Medicare PIN