Provider Demographics
NPI:1659595478
Name:EDWARDS, JUANITA (MD)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
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:P.O. BOX 106 DEPT #701
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77001-0106
Mailing Address - Country:US
Mailing Address - Phone:281-517-0060
Mailing Address - Fax:281-475-2045
Practice Address - Street 1:21216 NORTHWEST FWY STE 280
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-0017
Practice Address - Country:US
Practice Address - Phone:281-517-0060
Practice Address - Fax:281-475-2045
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7161208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200662904Medicaid
TX200662902Medicaid
TXP00722349OtherRAILROAD MEDICARE
TX200662903Medicaid
TXP00696343OtherRAILROAD MEDICARE
TXP00976901OtherRAILROAD MEDICARE
TX8BH922OtherBLUE CROSS BLUE SHIELD
TX200662901Medicaid
TX8F20827Medicare PIN
TX8F10262Medicare PIN
TXP00722349OtherRAILROAD MEDICARE
TX200662903Medicaid
TX200662902Medicaid