Provider Demographics
NPI:1568503852
Name:EDDS, GERALD G (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:G
Last Name:EDDS
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 1:2835 FARRELL CRES
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1393
Mailing Address - Country:US
Mailing Address - Phone:270-926-9033
Mailing Address - Fax:270-926-4896
Practice Address - Street 1:2835 FARRELL CRES
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1393
Practice Address - Country:US
Practice Address - Phone:270-926-9033
Practice Address - Fax:270-926-4896
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18970208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64189707Medicaid
1612501Medicare ID - Type Unspecified
KY64189707Medicaid