Provider Demographics
NPI:1093097735
Name:IWAY, EDSEL (MD)
Entity Type:Individual
Prefix:DR
First Name:EDSEL
Middle Name:
Last Name:IWAY
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 1:2855 S BRONCO ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5207
Mailing Address - Country:US
Mailing Address - Phone:412-519-5197
Mailing Address - Fax:702-685-7318
Practice Address - Street 1:2855 S BRONCO ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5207
Practice Address - Country:US
Practice Address - Phone:888-499-9273
Practice Address - Fax:702-926-9658
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15335207R00000X
IL036.133914207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV15335OtherNEVADA LICENSE