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General NPI Number Information
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NPI Number | 1669730180
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Entity Type | Individual
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Provider Name | THEODORE CARROLL EDWARDS M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/03/2012
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Last Update Date | 07/17/2018
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Provider Practice Location Address
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Address Line | 9709 3RD AVE NE FL 2
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City | SEATTLE
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State | WA
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Zip | 98115-2077
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Country | US
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Telephone | 206-860-2209
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Fax | 206-720-7449
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Provider Business Mailing Address
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Address Line | 240 PILGRIM RD
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City | WEST PALM BCH
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State | FL
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Zip | 33405-3380
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Country | US
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Telephone | 407-782-2457
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD60838557
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License Number State | WA
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