Provider Demographics
NPI:1235125212
Name:EDWARDS, DAVID G (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 404
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-0404
Mailing Address - Country:US
Mailing Address - Phone:801-619-2175
Mailing Address - Fax:877-428-7520
Practice Address - Street 1:550 E 1400 N STE Y
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2407
Practice Address - Country:US
Practice Address - Phone:435-757-6542
Practice Address - Fax:800-507-1652
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT105109-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTT77957Medicare UPIN
UT5166950001Medicare NSC