Healthcare Provider Details

I. General information

NPI: 1235484932
Provider Name (Legal Business Name): JOHN WARREN EDWARDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 UNIVERSITY BLVD
ROUND ROCK TX
78665-1032
US

IV. Provider business mailing address

PO BOX 840003
DALLAS TX
75284-0003
US

V. Phone/Fax

Practice location:
  • Phone: 512-509-0100
  • Fax: 512-218-6330
Mailing address:
  • Phone: 855-691-9890
  • Fax: 781-276-6487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR4962
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: