Healthcare Provider Details

I. General information

NPI: 1710234315
Provider Name (Legal Business Name): ANGELA EDWARDS D.P.M
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA EDWARDS DPM

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 S 8TH ST
DEMING NM
88030-4037
US

IV. Provider business mailing address

905 S 8TH ST
DEMING NM
88030-4037
US

V. Phone/Fax

Practice location:
  • Phone: 575-543-7200
  • Fax: 575-543-7209
Mailing address:
  • Phone: 575-543-7200
  • Fax: 575-543-7209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2160
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number383
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: