Provider Demographics
NPI:1568401701
Name:EDWARDS, DRALVES G (DO)
Entity Type:Individual
Prefix:DR
First Name:DRALVES
Middle Name:G
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:861 SW 78TH AVE
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3229
Mailing Address - Country:US
Mailing Address - Phone:954-693-0000
Mailing Address - Fax:954-693-0005
Practice Address - Street 1:777 E WHEATLAND RD STE 106
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4918
Practice Address - Country:US
Practice Address - Phone:972-685-5094
Practice Address - Fax:972-685-5108
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2689207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD97323Medicare UPIN