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General NPI Number Information
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NPI Number | 1730105172
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Entity Type | Organization
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Legal Business Name | STACY EDWARDS, INC
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 2623 MCCORMICK DR STE 101
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City | CLEARWATER
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State | FL
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Zip | 33759-1046
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Country | US
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Telephone | 727-564-9336
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Fax | 727-223-3228
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Provider Business Mailing Address
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Address Line | 1022 MAIN ST SUITE M
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City | DUNEDIN
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State | FL
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Zip | 34698-5225
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Country | US
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Telephone | 727-733-7922
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Fax | 737-738-6205
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. STACY L EDWARDS
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Credential | DO
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Telephone | 727-410-6655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OS7714
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License Number State | FL
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