Provider Demographics
NPI:1639147283
Name:EDWARDS, BRIAN R (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:R
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 KUHNE RD
Mailing Address - Street 2:CAPITAL REGION MEDICAL CLINIC OWENSVILLE
Mailing Address - City:OWENSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65066
Mailing Address - Country:US
Mailing Address - Phone:573-437-4168
Mailing Address - Fax:573-437-4242
Practice Address - Street 1:3536 KUHNE RD
Practice Address - Street 2:
Practice Address - City:OWENSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65066
Practice Address - Country:US
Practice Address - Phone:573-437-4168
Practice Address - Fax:573-437-4168
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003002799207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208842808Medicaid
189703OtherBLUE CROSS BLUE SHIELD
440546366OtherUNITED HEALTHCARE
P00189427OtherRR MEDICARE
2226070OtherFIRST HEALTH
8129934001OtherCIGNA
I13420OtherMERCY
661032OtherHEALTHLINK
I13420Medicare UPIN
MO208842808Medicaid