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NPI Code Detail

MEDICARE: DIANE IHEZIE EDWARDS MD

MEDICARE: DIANE IHEZIE 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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1245171982
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE IHEZIE EDWARDS MD
Provider Business Mailing Address
First Line : 6314 N MACARTHUR BLVD APT 4051
Second Line :
City : IRVING
State : TX
Zip : 75039-6102
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1400 8TH AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4110
Country : US
Telephone Number : 817-927-8299
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2026
Last Update Date : 04/06/2026

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