Provider Demographics
NPI:1871531350
Name:AGURA, EDWARD D (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:D
Last Name:AGURA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:3410 WORTH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2003
Practice Address - Country:US
Practice Address - Phone:214-370-1513
Practice Address - Fax:214-370-1585
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5681207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132167102Medicaid
TX132167107Medicaid
NM80122825Medicaid
OK100021710AMedicaid
TX8R1381OtherBLUE CROSS OF TEXAS
TX8K5063Medicare PIN
OK100021710AMedicaid
NM80122825Medicaid
TX830001548Medicare PIN