Healthcare Provider Details

I. General information

NPI: 1548376239
Provider Name (Legal Business Name): DAVID R. EDWARDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 QUADAY AVE NE
OTSEGO MN
55330-6522
US

IV. Provider business mailing address

4200 DAHLBERG DR SUITE 300
GOLDEN VALLEY MN
55422-4840
US

V. Phone/Fax

Practice location:
  • Phone: 763-441-0298
  • Fax: 763-441-0591
Mailing address:
  • Phone: 952-512-5600
  • Fax: 952-512-5651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number34787
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: