Healthcare Provider Details

I. General information

NPI: 1649296419
Provider Name (Legal Business Name): ROBERT BRUCE EDWARDS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 US HIGHWAY 70 E
NEBO NC
28761-9565
US

IV. Provider business mailing address

5920 US HIGHWAY 70 E
NEBO NC
28761-9565
US

V. Phone/Fax

Practice location:
  • Phone: 828-659-9703
  • Fax: 828-659-9357
Mailing address:
  • Phone: 828-659-9703
  • Fax: 828-659-9357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number102311
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: