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NPI Code Detail

MEDICARE: DR. THEODORE CARROLL EDWARDS M.D.

MEDICARE: DR. THEODORE CARROLL 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
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine PhysicianMD60838557WA

General Provider Information

NPI Number : 1669730180
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THEODORE CARROLL EDWARDS M.D.
Provider Business Mailing Address
First Line : 240 PILGRIM RD
Second Line :
City : WEST PALM BCH
State : FL
Zip : 33405-3380
Country : US
Telephone Number : 407-782-2457
Fax Number :
Provider Business Practice Location Address
First Line : 9709 3RD AVE NE FL 2
Second Line :
City : SEATTLE
State : WA
Zip : 98115-2077
Country : US
Telephone Number : 206-860-2209
Fax Number : 206-720-7449
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2012
Last Update Date : 07/17/2018

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