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NPI Code Detail

MEDICARE: RICKY D EDWARDS MD

MEDICARE: RICKY D 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
1207Q00000XFamily Medicine PhysicianE8450TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457358699
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICKY D EDWARDS MD
Provider Business Mailing Address
First Line : 1223 S MAIN ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4804
Country : US
Telephone Number : 817-702-7314
Fax Number : 817-702-7315
Provider Business Practice Location Address
First Line : 1223 S MAIN ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4804
Country : US
Telephone Number : 817-702-7314
Fax Number : 817-702-7315
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2005
Last Update Date : 12/04/2012

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