Basic Information
| Provider Information | |||||||||
| NPI: | 1417277518 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARDEEL | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | RAYMOND | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1140 BUSINESS CENTER DR STE 201 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770432744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139325757 | ||||||||
| FaxNumber: | 7139325750 | ||||||||
| Practice Location | |||||||||
| Address1: | 9250 PINECROFT DRIVE | ||||||||
| Address2: | |||||||||
| City: | THE WOODLANDS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773803218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137980190 | ||||||||
| FaxNumber: | 2813642535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2010 | ||||||||
| LastUpdateDate: | 08/19/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | P3113 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 282N00000X | BP10037422 | TX | N | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | BP10037422 | 01 | TX | PIT PERMIT | OTHER |