Provider Demographics
NPI:1427191790
Name:WREN, EDWARD J III (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:WREN
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 20452
Mailing Address - Street 2:YPS-CRED
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-0452
Mailing Address - Country:US
Mailing Address - Phone:614-442-2406
Mailing Address - Fax:614-442-2410
Practice Address - Street 1:1100 ANDRE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2159
Practice Address - Country:US
Practice Address - Phone:337-364-9225
Practice Address - Fax:337-364-6094
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2013-08-26
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Provider Licenses
StateLicense IDTaxonomies
LA015754207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1427191790OtherBCBS OF LA
LA1427191790OtherRR MEDICARE
LA1311111Medicaid
LA4E274CW36Medicare PIN