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General NPI Number Information
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NPI Number | 1114232691
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Entity Type | Organization
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Legal Business Name | J DAVID EDWARDS MD INC
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Dates
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Enumeration Date | 08/09/2010
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Last Update Date | 11/17/2010
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Provider Practice Location Address
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Address Line | 2001 SANTA MONICA BLVD SUITE 1265W
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City | SANTA MONICA
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State | CA
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Zip | 90404-2102
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Country | US
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Telephone | 310-828-8566
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Fax | 310-453-9531
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Provider Business Mailing Address
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Address Line | 2001 SANTA MONICA BLVD SUITE 1265W
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City | SANTA MONICA
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State | CA
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Zip | 90404-2102
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Country | US
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Telephone | 310-828-8566
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Fax | 310-453-9531
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN DAVID EDWARDS
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Credential | M.D.
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Telephone | 310-828-8566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | A26085
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License Number State | CA
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