Provider Demographics
NPI:1366552051
Name:EREZ, ELDAD (MD)
Entity type:Individual
Prefix:
First Name:ELDAD
Middle Name:
Last Name:EREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:1500 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2710
Practice Address - Country:US
Practice Address - Phone:682-885-6400
Practice Address - Fax:682-885-6101
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2317208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7875633OtherAETNA PIN
TX8F0032OtherBCBSTX IND PIN
TX00U87ZOtherBCBSTX GRP PIN
TX960519OtherPRONET PIN
TX140442852Medicaid
TX162708502Medicaid
TX8519989OtherCIGNA PIN
TX10012860OtherAMERIGROUP PIN
TX137345810Medicaid
TX142911100OtherFIRSTCARE PIN
TX4298410OtherBLUELINK PIN
TX5516562OtherCCN PIN
TX124136OtherSUPERIOR PIN
TX2405966OtherUHC PIN
1750369203OtherGRP NPI NUMBER
TX162708501Medicaid
TX2201095OtherFIRSTHEALTH PIN
TX00U87ZOtherBCBSTX GRP PIN
TX8519989OtherCIGNA PIN
TX10012860OtherAMERIGROUP PIN