Provider Demographics
NPI:1548205693
Name:DAVID EDWARDS MD PA
Entity Type:Organization
Organization Name:DAVID EDWARDS MD PA
Other - Org Name:FAMILY PRACTICE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-332-3366
Mailing Address - Street 1:997 RAINTREE CIRCLE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4950
Mailing Address - Country:US
Mailing Address - Phone:972-332-3366
Mailing Address - Fax:972-332-3375
Practice Address - Street 1:997 RAINTREE CIRCLE
Practice Address - Street 2:SUITE 140
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4950
Practice Address - Country:US
Practice Address - Phone:972-332-3366
Practice Address - Fax:972-332-3375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4301207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0029PCOtherBLUE CROSS BLUE SHIELD
TX0029PCOtherBLUE CROSS BLUE SHIELD
TXE67883Medicare UPIN