Healthcare Provider Details

I. General information

NPI: 1255530309
Provider Name (Legal Business Name): ROY DEWAYNE EDWARDS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E DOVE AVE STE 300
MCALLEN TX
78504-4682
US

IV. Provider business mailing address

PO BOX 2975
MCALLEN TX
78502-2975
US

V. Phone/Fax

Practice location:
  • Phone: 956-362-8170
  • Fax: 956-362-8168
Mailing address:
  • Phone: 956-362-8170
  • Fax: 956-362-8168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberQ5178
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberQ5178
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: