Healthcare Provider Details

I. General information

NPI: 1609915685
Provider Name (Legal Business Name): HOWARD BERRYMAN EDWARDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 09/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14205 SE 36TH ST 100
BELLEVUE WA
98006-1596
US

IV. Provider business mailing address

14205 SE 36TH ST 100
BELLEVUE WA
98006-1596
US

V. Phone/Fax

Practice location:
  • Phone: 425-998-6123
  • Fax:
Mailing address:
  • Phone: 425-998-6123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberMD00022387
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: