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General NPI Number Information
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NPI Number | 1972893055
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Entity Type | Individual
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Provider Name | JEFF T. EDWARDS N.D.
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Gender | Male
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 12616 SE STARK ST NAMASTE NATURAL HEALING CENTER INC.
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City | PORTLAND
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State | OR
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Zip | 97233
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Country | US
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Telephone | 503-408-0790
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Fax | 503-408-0791
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Provider Business Mailing Address
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Address Line | 12616 SE STARK ST BLDG. L PLAZA 125 NAMASTE NATURAL HEALING CENTER INC.
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City | PORTLAND
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State | OR
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Zip | 97233
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Country | US
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Telephone | 503-408-0790
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Fax | 503-408-0791
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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 | 175F00000X
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Taxonomy Name | Naturopath
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License Number | #1733
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | NT60168200
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License Number State | WA
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