Provider Demographics
NPI:1124000641
Name:EDWARDS, SCOTT ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ANDREW
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 1:5529 PENNOCK POINT RD
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3449
Mailing Address - Country:US
Mailing Address - Phone:561-398-7048
Mailing Address - Fax:
Practice Address - Street 1:5529 PENNOCK POINT RD
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3449
Practice Address - Country:US
Practice Address - Phone:561-398-7048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1038092085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3603538OtherAMERICHOICE- BERLIN
MD533151-04OtherCARE FIRST BCBS-SALISBURY
MD160541100Medicaid
MD533151-03OtherCARE FIRST BCBS - BERLIN
MDP00638352OtherRAIL ROAD MEDICARE
MD0336219000OtherAMERIHEALTH- BERLIN
MD233018OtherUNISON HEALTH
MD3603537OtherAMERICHOICE - SALISBURY
MD233018OtherUNISON HEALTH
MD092NS251Medicare PIN