Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 34226 | KY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 34226 | KY |
N | 207QA0505X | Family Doctor - Adult Medicine | 34226 | KY |
NPI | 1902816549 |
---|---|
Provider Name | Dr. Wayne R. Edwards |
First Address | Pikeville, KY 41501-1430 |
Second Address | Inez, KY 41224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 31/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000297028 | ANTHEM BC/BS (01) | KY |
64050271 | (05) | KY |
H35616 | (02) | KY |