MEDICARE: DR. JARED RAY EDWARDS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171000000X	Military Health Care Provider
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1457905853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JARED RAY EDWARDS MD

Provider Business Mailing Address
First Line	:	34800 BOB WILSON DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92134-1098
Country	:	US
Telephone Number	:	619-532-8666
Fax Number	:

Provider Business Practice Location Address
First Line	:	34800 BOB WILSON DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92134-3011
Country	:	US
Telephone Number	:	619-532-8666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2019
Last Update Date	:	08/16/2022

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