MEDICARE: THOMAS L EDWARDS DO INC

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	207QG0300X	Geriatric Medicine (Family Medicine) Physician

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

General Provider Information

NPI Number	:	1447439229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS L EDWARDS DO INC

Provider Business Mailing Address
First Line	:	12844 JOE HARIG ROAD
Second Line	:
City	:	SAN ANTONIO
State	:	FL
Zip	:	33576
Country	:	US
Telephone Number	:	352-588-0476
Fax Number	:	888-523-3008

Provider Business Practice Location Address
First Line	:	12844 JOE HARIG ROAD
Second Line	:
City	:	SAN ANTONIO
State	:	FL
Zip	:	33576
Country	:	US
Telephone Number	:	352-588-0476
Fax Number	:	888-523-3008

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS LLOYD EDWARDS
Credential	:	DO
Telephone Number	:	352-588-0476

Provider Enumeration Date	:	10/30/2007
Last Update Date	:	06/27/2016

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