Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 057799 | GA |
N | 208600000X | Surgeon | 057799 | GA |
N | 208200000X | Surgeon | 223815 | MA |
N | 208600000X | Surgeon | 223815 | MA |
N | 208200000X | Surgeon | MD450548 | PA |
N | 208600000X | Surgeon | MD450548 | PA |
Y | 208200000X | Surgeon | ME136929 | FL |
Y | 208600000X | Surgeon | ME136929 | FL |
NPI | 1013967884 |
---|---|
Provider Name | Dr. Michael Anthony Edwards |
First Address | Jacksonville, FL 32224-1865 |
Second Address | Jacksonville, FL 32224-1865 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 31/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
710203021A | (05) | GA |
710203021B | (05) | GA |
710203021C | (05) | GA |
710203021D | (05) | GA |
710203021E | (05) | GA |
G57799 | (05) | SC |
I29258 | (02) | GA |
P00423698 | RAILROAD MEDICARE (01) | GA |