Provider Demographics
NPI:1568721454
Name:EDWARDS, JASON MATTHEW (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:MATTHEW
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF RADIATION MEDICINE 800 ROSE ST
Mailing Address - Street 2:ROOM CC003B
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0293
Mailing Address - Country:US
Mailing Address - Phone:816-824-9855
Mailing Address - Fax:
Practice Address - Street 1:232 S WOODS MILL RD STE 110E
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:314-542-4998
Practice Address - Fax:314-542-4739
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYR29172085R0001X
MO20170119052085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology