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General NPI Number Information
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NPI Number | 1497291124
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Entity Type | Organization
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Legal Business Name | WB EDWARDS MD LLC
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Dates
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Enumeration Date | 01/19/2017
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Last Update Date | 03/15/2017
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Provider Practice Location Address
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Address Line | 1607 LISENBY AVE SUITE D
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City | PANAMA CITY
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State | FL
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Zip | 32405-3796
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Country | US
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Telephone | 850-250-3360
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Fax | 850-640-3798
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Provider Business Mailing Address
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Address Line | 1607 LISENBY AVE SUITE D
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City | PANAMA CITY
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State | FL
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Zip | 32405-3796
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Country | US
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Telephone | 850-250-3360
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Fax | 850-640-3798
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILSON BARTON EDWARDS JR.
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Credential | M.D.
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Telephone | 850-250-3360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084F0202X
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Taxonomy Name | Forensic Psychiatry Physician
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License Number | ME65288
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME65288
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License Number State | FL
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