Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | MD427825 | PA |
N | 208D00000X | General Practice Physician | MD427825 | PA |
NPI | 1134176142 |
---|---|
Provider Name | Mr. Earl Wilbert Edwards |
First Address | York, PA 17403-4594 |
Second Address | York, PA 17403-4594 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 07/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H-68139 | (02) | PA |