MEDICARE: ROBERT BRUCE EDWARDS PA-C

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	207Q00000X	Family Medicine Physician	102311	NC

General Provider Information

NPI Number	:	1649296419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT BRUCE EDWARDS PA-C

Provider Business Mailing Address
First Line	:	5920 US HIGHWAY 70 E
Second Line	:
City	:	NEBO
State	:	NC
Zip	:	28761-9565
Country	:	US
Telephone Number	:	828-659-9703
Fax Number	:	828-659-9357

Provider Business Practice Location Address
First Line	:	5920 US HIGHWAY 70 E
Second Line	:
City	:	NEBO
State	:	NC
Zip	:	28761-9565
Country	:	US
Telephone Number	:	828-659-9703
Fax Number	:	828-659-9357

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	04/02/2013

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