Provider Demographics
NPI:1073598710
Name:EDWARDS, ROBERT WILSON (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILSON
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1046
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-1046
Mailing Address - Country:US
Mailing Address - Phone:304-327-1890
Mailing Address - Fax:304-325-1905
Practice Address - Street 1:488 CHERRY ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-3304
Practice Address - Country:US
Practice Address - Phone:304-327-1890
Practice Address - Fax:304-325-1908
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19543207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1802151000Medicaid
VA0062171336217133Medicaid
WVED4027332Medicare ID - Type Unspecified
WVH19618Medicare UPIN