Provider Demographics
NPI:1598854895
Name:EDWARDS, JAMES LEROY (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEROY
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:515 ST MARYS STREET
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1774
Mailing Address - Country:US
Mailing Address - Phone:919-833-4324
Mailing Address - Fax:919-833-2630
Practice Address - Street 1:515 ST MARYS STREET
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1774
Practice Address - Country:US
Practice Address - Phone:919-833-4324
Practice Address - Fax:919-833-2630
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC166213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
42135OtherCOVENTRY HEALTH PLAN WELL
5161534OtherAETNA INSURANCE
T64066OtherCIGNA HEALTH CARE
NC08056OtherBC AND BS
40502OtherPARTNERS
NC8908056Medicaid
259331OtherONE NET
NC2752356OtherUHC
95658OtherMEDCOST
NC2752356OtherUHC
40502OtherPARTNERS