Provider Demographics
NPI:1497291124
Name:WB EDWARDS MD LLC
Entity Type:Organization
Organization Name:WB EDWARDS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:BARTON
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:850-250-3360
Mailing Address - Street 1:1607 LISENBY AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3796
Mailing Address - Country:US
Mailing Address - Phone:850-250-3360
Mailing Address - Fax:850-640-3798
Practice Address - Street 1:1607 LISENBY AVE
Practice Address - Street 2:SUITE D
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3796
Practice Address - Country:US
Practice Address - Phone:850-250-3360
Practice Address - Fax:850-640-3798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME652882084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25657XMedicare UPIN
FL275982900Medicaid