Basic Information
| Provider Information | |||||||||
| NPI: | 1871856450 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARAIZA | ||||||||
| FirstName: | EDGAR | ||||||||
| MiddleName: | TEODORO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 W. COLORADO BLVD. | ||||||||
| Address2: | PAVILION II SUITE 431 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149473684 | ||||||||
| FaxNumber: | 2149473686 | ||||||||
| Practice Location | |||||||||
| Address1: | 221 W. COLORADO BLVD. | ||||||||
| Address2: | PAVILION II SUITE 431 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149473684 | ||||||||
| FaxNumber: | 2149473686 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2012 | ||||||||
| LastUpdateDate: | 05/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 2017-00802 | NC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | R6516 | TX | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0801X | 2017-00802 | NC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma | 207XX0801X | R6516 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma |
No ID Information.