Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | C8267 | TX |
NPI | 1174603419 |
---|---|
Provider Name | Creighton L Edwards |
First Address | Houston, TX 77210-4775 |
Second Address | Houston, TX 77030-2348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 23/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
128874804 | (05) | TX |
C15441 | (02) |