Provider Demographics
NPI:1356370464
Name:EDEN, BILLY MAX (MD)
Entity type:Individual
Prefix:DR
First Name:BILLY
Middle Name:MAX
Last Name:EDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6400
Mailing Address - Fax:
Practice Address - Street 1:120 E CHARNWOOD ST
Practice Address - Street 2:STE B
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1708
Practice Address - Country:US
Practice Address - Phone:903-525-1664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8094207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8FS313OtherBCBS
TXP01628359OtherRAIL ROAD MEDICARE
TX75-2616977-026OtherTRICARE
TX109389001Medicaid
TX131961809Medicaid
TX75-2616977-129OtherTRICARE
TX8FS313OtherBCBS
TX417118YMAFMedicare PIN
TX8C2595Medicare PIN