Healthcare Provider Details

I. General information

NPI: 1700811825
Provider Name (Legal Business Name): TERRY H EDWARDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 ENCINO PL NE SUITE 3
ALBUQUERQUE NM
87102-2611
US

IV. Provider business mailing address

PO BOX 51375
ALBUQUERQUE NM
87181-1375
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-2141
  • Fax: 505-245-7117
Mailing address:
  • Phone: 505-242-4599
  • Fax: 505-242-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number9140
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: