Provider Demographics
NPI:1417396227
Name:EDWARDS, CEAZON TRISMEGISTUS (MD)
Entity Type:Individual
Prefix:DR
First Name:CEAZON
Middle Name:TRISMEGISTUS
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 1:8210 WALNUT HILL LN STE 505
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4420
Mailing Address - Country:US
Mailing Address - Phone:214-345-4160
Mailing Address - Fax:214-345-4165
Practice Address - Street 1:8210 WALNUT HILL LN STE 505
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4420
Practice Address - Country:US
Practice Address - Phone:214-345-4160
Practice Address - Fax:214-345-4165
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU62282086S0129X
MI4301103542208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty