Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 23381 | OK |
NPI | 1083766703 |
---|---|
Provider Name | Dr. Dearborn Edwards |
First Address | Seminole, OK 74818-1306 |
Second Address | Oklahoma City, OK 73104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 08/07/2007 |