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NPI Code Detail

MEDICARE: DAVID LYNDON EDWARDY D.O.

MEDICARE: DAVID LYNDON EDWARDY D.O.
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 Physician38805MN

General Provider Information

NPI Number : 1699765982
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID LYNDON EDWARDY D.O.
Provider Business Mailing Address
First Line : 2200 26TH ST NW
Second Line :
City : OWATONNA
State : MN
Zip : 55060
Country : US
Telephone Number : 507-451-1120
Fax Number : 507-444-5037
Provider Business Practice Location Address
First Line : 2110 E CENTER ST
Second Line :
City : ROCHESTER
State : MN
Zip : 55904-4754
Country : US
Telephone Number : 507-287-0674
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2005
Last Update Date : 06/03/2010

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