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Mr. Edgar De La Fuente, LICENSEDPROSTHETIST
Prosthetic/Orthotic Supplier in Longview, Texas
NPI 1750323713

Edgar De La Fuente is a Prosthetic/Orthotic Supplier based in Longview, TX. Edgar De La Fuente practices in Longview, TX and has the professional credentials of LICENSEDPROSTHETIST. The NPI Number for Edgar De La Fuente is 1750323713 and holds a License No. 233 (Texas).

The current practice location address for Edgar De La Fuente is 719 N. Second Street, Longview, TX and can be reached out via phone at 903-553-1040 and via fax at 903-553-9996.

Location: 719 N. Second Street, Longview, TX, 75601-5316
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1750323713
Provider Name
Edgar De La Fuente
Credential
LICENSEDPROSTHETIST
Provider Entity Type
Individual
Gender
Male
Address
719 N. Second Street, Longview, TX, 75601-5316
Phone Number
903-553-1040
Fax Number
903-553-9996
Provider Enumeration Date
06/12/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1750323713 01 TX NPI
531976 01 TX BCBS OF TEXAS
168459901 05 TX
institution
Provider Business Practice Location Address Details
Address
719 N. Second Street
City
Longview
State
Texas
Zip
75601-5316
Phone Number
903-553-1040
Fax Number
903-553-9996
person
Provider Business Mailing Address Details
Address
719 N. Second Street
City
Longview
State
Texas
Zip
75601-5316
Phone Number
903-553-1040
Fax Number
903-553-9996
person
Provider's Taxonomy Details 1
Type
Suppliers
Classification
Prosthetic/Orthotic Supplier
Speciality
-
Taxonomy
335E00000X
License No.
233 (Texas)
Definition
An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition.
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