Provider Demographics
NPI:1093719486
Name:EDWARDS, WILLIAM LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LOUIS
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 W ELK AVE
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1571
Mailing Address - Country:US
Mailing Address - Phone:580-252-6080
Mailing Address - Fax:580-470-2967
Practice Address - Street 1:2515 W ELK AVE
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1571
Practice Address - Country:US
Practice Address - Phone:580-252-6080
Practice Address - Fax:580-470-2967
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8311208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100109750AMedicaid
OKD38764Medicare UPIN