Healthcare Provider Details

I. General information

NPI: 1548642580
Provider Name (Legal Business Name): ALAN DRAKE BOWLES EDWARDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 12/04/2021
Certification Date: 12/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 VALLEY VIEW DR STE 100
MOLINE IL
61265-6152
US

IV. Provider business mailing address

520 VALLEY VIEW DR. STE 100
MOLINE IL
61265-6194
US

V. Phone/Fax

Practice location:
  • Phone: 309-762-3621
  • Fax:
Mailing address:
  • Phone: 309-762-3621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301107795
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number036.158287
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: