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NPI Code Detail

MEDICARE: DR. BILL EDWARDS DO

MEDICARE: DR. BILL EDWARDS DO
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 Physician2365OK

General Provider Information

NPI Number : 1770572281
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BILL EDWARDS DO
Provider Business Mailing Address
First Line : 1705 RENAISSANCE BLVD
Second Line : SUITE 100
City : EDMOND
State : OK
Zip : 73013-3041
Country : US
Telephone Number : 405-285-7500
Fax Number : 405-285-7501
Provider Business Practice Location Address
First Line : 13420 N PENNSYLVANIA AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73120-9007
Country : US
Telephone Number : 405-478-0633
Fax Number : 405-478-5218
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2005
Last Update Date : 04/18/2011

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