Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 35-067118 | OH |
NPI | 1053321794 |
---|---|
Provider Name | Dr. Peter H Edwards JR. |
First Address | Upper Arlington, OH 43220-2246 |
Second Address | Upper Arlington, OH 43220-2246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 03/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0992583 | (05) | OH |
F89379 | (02) | OH |