Doctor Name: | HANNIBAL EDWARDS |
NPI Number: | 1760808539 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 52552 |
Business Practice Address: | 19814 Tomahawk Rd Apple Valley, CA - 923075054 |
Business Phone Number: | 7602421903 |
Business Fax Number: | |
Mailing Address: | Po Box 1153, APPLE VALLEY |
State: | CA |
Postal Code: | 923070020 |
Phone Number: | 7602421903 |
Fax Number: | |
NPI Enumeration Date: | 03/17/2014 |
NPI Last Update Date: | 03/17/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 52552 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |