Provider Demographics
NPI:1508972308
Name:EDWARDS, JAMES CLIFFORD (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CLIFFORD
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 TURNPIKE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-1232
Mailing Address - Country:US
Mailing Address - Phone:814-768-2470
Mailing Address - Fax:814-768-2374
Practice Address - Street 1:809 TURNPIKE AVE
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-1232
Practice Address - Country:US
Practice Address - Phone:814-768-2470
Practice Address - Fax:814-768-2374
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-040316L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA532460Medicare ID - Type Unspecified
PAE64238Medicare UPIN