Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | Q5178 | TX |
N | 208600000X | Surgeon | Q5178 | TX |
Y | 2086S0102X | Surgical Critical Care | Q5178 | TX |
NPI | 1255530309 |
---|---|
Provider Name | Dr. Roy Dewayne Edwards |
First Address | Mcallen, TX 78502-4449 |
Second Address | Mcallen, TX 78504-4682 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2007 |
Last Update Date | 13/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q5178 | TEXAS MEDICAL BOARD LICENSE (01) | TX |