Doctor Name: | OLIVER L EDWARDS |
NPI Number: | 1871796508 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 01065944A |
Business Practice Address: | 280 1st St Holloman Afb, NM - 883308273 |
Business Phone Number: | 5755727985 |
Business Fax Number: | 5755723182 |
Mailing Address: | 3902 Basswood Dr, ALAMOGORDO |
State: | NM |
Postal Code: | 883108267 |
Phone Number: | 5754378528 |
Fax Number: | 5755723182 |
NPI Enumeration Date: | 06/08/2007 |
NPI Last Update Date: | 02/24/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 01065944A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |