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General NPI Number Information
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NPI Number | 1336371723
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Entity Type | Organization
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Legal Business Name | MICHAEL EDWARDS, D.P.M., P.A. PODIATRIST
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Dates
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Enumeration Date | 08/18/2009
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Last Update Date | 08/13/2010
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Provider Practice Location Address
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Address Line | 800 E 7TH ST
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City | ODESSA
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State | TX
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Zip | 79761-4612
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Country | US
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Telephone | 432-332-1056
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Fax | 866-982-9030
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Provider Business Mailing Address
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Address Line | 800 E 7TH ST
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City | ODESSA
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State | TX
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Zip | 79761-4612
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Country | US
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Telephone | 432-332-1056
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Fax | 866-982-9030
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL JACK EDWARDS
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Credential | D.P.M.
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Telephone | 432-934-4328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 1879
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License Number State | TX
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