MEDICARE: DR. DEAN A EDWARDS 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	207RG0100X	Gastroenterology Physician	MD105287	MO

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	:	1487624557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEAN A EDWARDS M.D.

Provider Business Mailing Address
First Line	:	477 KENSINGTON LN
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-8428
Country	:	US
Telephone Number	:	573-334-4969
Fax Number	:	573-334-7340

Provider Business Practice Location Address
First Line	:	1429 N MOUNT AUBURN RD
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-2171
Country	:	US
Telephone Number	:	573-334-8870
Fax Number	:	573-388-2310

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	07/01/2014

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