Provider Demographics
NPI:1114198736
Name:EDWARDS, KERRY IVAN (MD)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:IVAN
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 1:18912 NW 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-7589
Mailing Address - Country:US
Mailing Address - Phone:352-256-3288
Mailing Address - Fax:386-418-4335
Practice Address - Street 1:18912 NW 76TH AVE
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-7589
Practice Address - Country:US
Practice Address - Phone:352-256-3288
Practice Address - Fax:386-418-4335
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0051192207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine