Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 2011-00252 | NC |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | E6910 | AR |
NPI | 1235289596 |
---|---|
Provider Name | Paul K Edwards |
First Address | Little Rock, AR 72205-5202 |
Second Address | Little Rock, AR 72205-5202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 13/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
193595001 | (05) | AR |
5917378 | (05) | NC |
NC1369 | (05) | SC |