MEDICARE: GEORGE KEITH 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	207U00000X	Nuclear Medicine Physician	G59625	CA

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
2	00G596250	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1538125489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE KEITH EDWARDS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 48904
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-0904
Country	:	US
Telephone Number	:	310-449-1188
Fax Number	:	310-449-9136

Provider Business Practice Location Address
First Line	:	1328 22ND ST
Second Line	:	DEPARTMENT OF NUCLEAR MEDICINE
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-2032
Country	:	US
Telephone Number	:	310-829-8229
Fax Number	:	310-449-9136

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

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	05/14/2008

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