Healthcare Provider Details

I. General information

NPI: 1093719486
Provider Name (Legal Business Name): WILLIAM LOUIS EDWARDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 W ELK AVE
DUNCAN OK
73533-1571
US

IV. Provider business mailing address

2515 W ELK AVE
DUNCAN OK
73533-1571
US

V. Phone/Fax

Practice location:
  • Phone: 580-252-6080
  • Fax: 580-470-2967
Mailing address:
  • Phone: 580-252-6080
  • Fax: 580-470-2967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number8311
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: