Healthcare Provider Details

I. General information

NPI: 1649299199
Provider Name (Legal Business Name): JOHN EDWARDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N. FRESNO ST. 370
FRESNO CA
93701
US

IV. Provider business mailing address

1840 SHAW AVE STE 105
CLOVIS CA
93611-4002
US

V. Phone/Fax

Practice location:
  • Phone: 559-459-2327
  • Fax: 559-459-1539
Mailing address:
  • Phone: 559-443-2682
  • Fax: 559-443-2681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberG38967
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: