Healthcare Provider Details

I. General information

NPI: 1346339322
Provider Name (Legal Business Name): RODNEY DARWIN EDWARDS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 E 19TH ST
HUNTINGBURG IN
47542-9388
US

IV. Provider business mailing address

1173 GARRISON DR
ST AUGUSTINE FL
32092-1023
US

V. Phone/Fax

Practice location:
  • Phone: 812-683-4717
  • Fax: 812-683-4764
Mailing address:
  • Phone: 904-287-1053
  • Fax: 904-287-1053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01028294A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME 90997
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: