MEDICARE: DR. ROXANNE L 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	208000000X	Pediatrics Physician	ME0055092	FL
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	ME0055092	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2008-00902	OTHER	NC	STATE PROFESSIONAL LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154468734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROXANNE L EDWARDS MD

Provider Business Mailing Address
First Line	:	2434 S GLENCOE RD
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-9360
Country	:	US
Telephone Number	:	285-424-9740
Fax Number	:

Provider Business Practice Location Address
First Line	:	2434 S GLENCOE RD
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-9360
Country	:	US
Telephone Number	:	285-424-9740
Fax Number	:

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	12/16/2019

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