Healthcare Provider Details

I. General information

NPI: 1073561940
Provider Name (Legal Business Name): CHRISTINE EDWARDS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 S KIRKMAN RD
ORLANDO FL
32811-2346
US

IV. Provider business mailing address

7123 SHADY WOOD LN
ORLANDO FL
32835-2724
US

V. Phone/Fax

Practice location:
  • Phone: 407-362-2030
  • Fax: 407-362-2040
Mailing address:
  • Phone: 407-296-5525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME 79024
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: