Provider Demographics
NPI:1558423103
Name:EDWARDS, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
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 1:12121 RICHMOND AVE
Mailing Address - Street 2:SUITE 224
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2432
Mailing Address - Country:US
Mailing Address - Phone:281-596-9170
Mailing Address - Fax:
Practice Address - Street 1:12121 RICHMOND AVE
Practice Address - Street 2:SUITE 224
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2432
Practice Address - Country:US
Practice Address - Phone:281-596-9170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6189207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83Z060Medicare ID - Type Unspecified
TXE73894Medicare UPIN