Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DS017993 | PA |
NPI | 1679561393 |
---|---|
Provider Name | Dr. Paul Allen Edwards |
First Address | Centerville, OH 45459-4924 |
Second Address | Wpafb, OH 45433-5546 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2005 |
Last Update Date | 08/07/2007 |