MEDICARE: DR. COLBY LEE EDWARDS D.O.

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	207P00000X	Emergency Medicine Physician	4400	OK

General Provider Information

NPI Number	:	1114093655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLBY LEE EDWARDS D.O.

Provider Business Mailing Address
First Line	:	1212 MARY LEE LN
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-5427
Country	:	US
Telephone Number	:	405-471-6112
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 S DOUGLAS AVE STE 306
Second Line	:	ISMC EMERGENCY MEDICINE
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3215
Country	:	US
Telephone Number	:	405-636-7195
Fax Number	:

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

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	10/16/2012

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