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General NPI Number Information
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NPI Number | 1063623882
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Entity Type | Organization
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Legal Business Name | JOHN B. EDWARDS, MD PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 04/23/2015
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Provider Practice Location Address
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Address Line | 5680 N FRESNO ST SUITE 107
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City | FRESNO
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State | CA
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Zip | 93710-8331
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Country | US
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Telephone | 559-435-1800
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Fax | 559-432-6435
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Provider Business Mailing Address
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Address Line | 5680 N FRESNO ST SUITE 107
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City | FRESNO
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State | CA
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Zip | 93710-8331
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Country | US
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Telephone | 559-435-1800
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Fax | 559-432-6435
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Authorized Official
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Title or Position | OWNER
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Name | JOHN B EDWARDS
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Credential | MD
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Telephone | 559-435-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | G38967
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License Number State | CA
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