Provider Demographics
NPI:1669472544
Name:ASSI, EDWARD RALPH (DO)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:RALPH
Last Name:ASSI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1700 CLIFF, BLDG A
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902
Mailing Address - Country:US
Mailing Address - Phone:915-577-9009
Mailing Address - Fax:915-577-9006
Practice Address - Street 1:1700 CLIFF, BLDG A
Practice Address - Street 2:SUITE 200
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902
Practice Address - Country:US
Practice Address - Phone:915-577-9009
Practice Address - Fax:915-577-9006
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK5782207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1446858-07Medicaid
TXP00060917OtherMEDICARE RAILROAD
TX8K0980OtherBLUE CROSS BLUE SHIELD
TXP00060917OtherMEDICARE RAILROAD
8A9001Medicare PIN