Provider Demographics
NPI:1568863439
Name:EDWARDS, JAMES FREDERICK (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:FREDERICK
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 1:24230 SUMMIT WOODS DR
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95033-9294
Mailing Address - Country:US
Mailing Address - Phone:408-460-6356
Mailing Address - Fax:
Practice Address - Street 1:24230 SUMMIT WOODS DR
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95033-9294
Practice Address - Country:US
Practice Address - Phone:408-460-6356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG26979174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist