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NPI Code Detail

MEDICARE: DR. REBECCA L EDGEWORTH MD

MEDICARE: DR. REBECCA L EDGEWORTH MD
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
1207R00000XInternal Medicine PhysicianCS19621NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1LL1470OTHERNVMEDICAL LICENSE

General Provider Information

NPI Number : 1730203233
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. REBECCA L EDGEWORTH MD
Provider Business Mailing Address
First Line : 1240 NORTH MARTIN L KING JR BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106
Country : US
Telephone Number : 702-967-0530
Fax Number : 702-967-0538
Provider Business Practice Location Address
First Line : 1240 N MARTIN LUTHER KING BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-2825
Country : US
Telephone Number : 702-967-0530
Fax Number : 702-967-0538
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2007
Last Update Date : 03/07/2023

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