Healthcare Provider Details

I. General information

NPI: 1598215105
Provider Name (Legal Business Name): JUANITA P EDWARDS MD & ASSOC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7508 CYPRESS CREEK PKWY
HOUSTON TX
77070-5806
US

IV. Provider business mailing address

7508 CYPRESS CREEK PKWY
HOUSTON TX
77070-5806
US

V. Phone/Fax

Practice location:
  • Phone: 281-788-2944
  • Fax: 281-817-6699
Mailing address:
  • Phone: 281-788-2944
  • Fax: 281-817-6699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberM7161
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JUANITA P EDWARDS
Title or Position: OWNER
Credential: M.D.
Phone: 281-788-2944