Healthcare Provider Details

I. General information

NPI: 1902642994
Provider Name (Legal Business Name): EDWARDS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 RAIDERS WAY
HENDERSON NV
89052-4670
US

IV. Provider business mailing address

PO BOX 80806
CITY OF INDUSTRY CA
91716-8420
US

V. Phone/Fax

Practice location:
  • Phone: 702-963-7000
  • Fax:
Mailing address:
  • Phone: 310-321-0143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: IRV EDWARDS
Title or Position: PRESIDENT
Credential: MD
Phone: 310-321-0143