Healthcare Provider Details

I. General information

NPI: 1154884955
Provider Name (Legal Business Name): ISAAC TROY EDWARDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 PAN AMERICAN FREEWAY NE STE 200
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-823-8282
  • Fax: 505-823-8275
Mailing address:
  • Phone: 505-823-8282
  • Fax: 505-823-8275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2026-257
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: