Provider Demographics
NPI:1154468734
Name:EDWARDS, ROXANNE L (MD)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:L
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2434 S GLENCOE RD
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-9360
Mailing Address - Country:US
Mailing Address - Phone:285-424-9740
Mailing Address - Fax:
Practice Address - Street 1:2434 S GLENCOE RD
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-9360
Practice Address - Country:US
Practice Address - Phone:285-424-9740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055092208000000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063395000Medicaid
NC2008-00902OtherSTATE PROFESSIONAL LICENSE