MEDICARE: EDWARD EADES M.D.

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	208200000X	Plastic Surgery Physician	19656	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MD19656	OTHER	AZ	MEDICARE ID

General Provider Information

NPI Number	:	1245295864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD EADES M.D.

Provider Business Mailing Address
First Line	:	2940 N SWAN RD
Second Line	:	#130
City	:	TUCSON
State	:	AZ
Zip	:	85712
Country	:	US
Telephone Number	:	520-323-6994
Fax Number	:	520-733-0787

Provider Business Practice Location Address
First Line	:	2940 N SWAN RD
Second Line	:	130
City	:	TUCSON
State	:	AZ
Zip	:	85712-5601
Country	:	US
Telephone Number	:	520-323-6994
Fax Number	:	520-733-0787

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	06/16/2021

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