MEDICARE: DR. KEVIN ROBERT EDWARDS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	94-40	NM

General Provider Information

NPI Number	:	1093770703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN ROBERT EDWARDS MD

Provider Business Mailing Address
First Line	:	3000 10TH ST NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-1113
Country	:	US
Telephone Number	:	505-345-9887
Fax Number	:

Provider Business Practice Location Address
First Line	:	NM VAHCS
Second Line	:	1501 SAN PEDRO, SE
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108
Country	:	US
Telephone Number	:	505-265-1711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	07/08/2007

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