MEDICARE: STEVEN RAY EDMONDSON 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	207VG0400X	Gynecology Physician	G8830	TX
2	207V00000X	Obstetrics & Gynecology Physician	G8830	TX
3	207VX0000X	Obstetrics Physician	G8830	TX

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	83022Y	OTHER	TX	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	0737147	OTHER	TX	UNITED HEALTHCARE
8	2357545	OTHER	TX	AETNA

General Provider Information

NPI Number	:	1164429890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN RAY EDMONDSON MD

Provider Business Mailing Address
First Line	:	3025 N TARRANT PKWY
Second Line	:	SUITE 240
City	:	FORT WORTH
State	:	TX
Zip	:	76177-8620
Country	:	US
Telephone Number	:	817-431-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	3025 N TARRANT PKWY
Second Line	:	SUITE 240
City	:	FORT WORTH
State	:	TX
Zip	:	76177-8620
Country	:	US
Telephone Number	:	817-431-1500
Fax Number	:

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	10/15/2016

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Directions to “ STEVEN RAY EDMONDSON MD” Practice Location

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