Provider Demographics
NPI:1619943669
Name:KRIS, EDWARD STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:STEPHEN
Last Name:KRIS
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 1:2800 S SEACREST BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7961
Mailing Address - Country:US
Mailing Address - Phone:561-734-1888
Mailing Address - Fax:
Practice Address - Street 1:2800 S SEACREST BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7961
Practice Address - Country:US
Practice Address - Phone:561-734-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71114208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL186635OtherAMERIGROUP
FL42547OtherBLUE CROSS BLUE SHIELD
FL266397000Medicaid