Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 1131 | AL |
NPI | 1053322982 |
---|---|
Provider Name | Dr. Gary Forrest Edwards |
First Address | Alabaster, AL 35007-2053 |
Second Address | Hoover, AL 35226-4182 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 13/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
510-01421 | BCBS (01) | AL |
T73795 | (02) | AL |