Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 6652 | WA |
NPI | 1598974339 |
---|---|
Provider Name | Dr. Darrell Rick Edwards |
First Address | Federal Way, WA 98023-2568 |
Second Address | Federal Way, WA 98023-2568 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 07/10/2016 |