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General NPI Number Information
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NPI Number | 1538125489
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Entity Type | Individual
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Provider Name | GEORGE KEITH EDWARDS M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 1328 22ND ST DEPARTMENT OF NUCLEAR MEDICINE
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City | SANTA MONICA
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State | CA
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Zip | 90404-2032
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Country | US
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Telephone | 310-829-8229
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Fax | 310-449-9136
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Provider Business Mailing Address
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Address Line | PO BOX 48904
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City | LOS ANGELES
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State | CA
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Zip | 90048-0904
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Country | US
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Telephone | 310-449-1188
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Fax | 310-449-9136
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number | G59625
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License Number State | CA
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