Healthcare Provider Details

I. General information

NPI: 1235125212
Provider Name (Legal Business Name): DAVID G EDWARDS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E 1400 N STE Y
LOGAN UT
84341-2407
US

IV. Provider business mailing address

PO BOX 404
RIVERTON UT
84065-0404
US

V. Phone/Fax

Practice location:
  • Phone: 435-757-6542
  • Fax: 800-507-1652
Mailing address:
  • Phone: 801-619-2175
  • Fax: 877-428-7520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number105109-0501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: