MEDICARE: DAVID EDWARDS MD PA

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	207Q00000X	Family Medicine Physician	H4301	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0029PC	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1548205693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID EDWARDS MD PA

Provider Business Mailing Address
First Line	:	997 RAINTREE CIRCLE
Second Line	:	SUITE 140
City	:	ALLEN
State	:	TX
Zip	:	75013-4950
Country	:	US
Telephone Number	:	972-332-3366
Fax Number	:	972-332-3375

Provider Business Practice Location Address
First Line	:	997 RAINTREE CIRCLE
Second Line	:	SUITE 140
City	:	ALLEN
State	:	TX
Zip	:	75013-4950
Country	:	US
Telephone Number	:	972-332-3366
Fax Number	:	972-332-3375

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. DAVID EDWARDS
Credential	:	M.D.
Telephone Number	:	972-332-3366

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	05/02/2008

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