Healthcare Provider Details

I. General information

NPI: 1356584676
Provider Name (Legal Business Name): JASON R. EDWARDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2009
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3719 DAUPHIN STREET
MOBILE AL
36608
US

IV. Provider business mailing address

1613 N. HARRISON PARKWAY SUITE 200 MAILSTOP SH-9A
SUNRISE FL
33323-2896
US

V. Phone/Fax

Practice location:
  • Phone: 251-344-9630
  • Fax: 954-851-1746
Mailing address:
  • Phone: 800-437-2672
  • Fax: 954-851-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD.32569
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: