Healthcare Provider Details

I. General information

NPI: 1871988972
Provider Name (Legal Business Name): JEFFREY BRYANT EDWARDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N CATTLEMEN RD STE 220
SARASOTA FL
34232-6422
US

IV. Provider business mailing address

600 N CATTLEMEN RD STE 220
SARASOTA FL
34232-6422
US

V. Phone/Fax

Practice location:
  • Phone: 941-371-6565
  • Fax: 941-377-7731
Mailing address:
  • Phone: 419-371-6565
  • Fax: 941-377-7731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME132518
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: