Provider Demographics
NPI:1700853793
Name:EDWARDS, GREGORY ASHTON (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ASHTON
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:729-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:802 MEDICAL DR
Practice Address - Street 2:SUITE 400
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5100
Practice Address - Country:US
Practice Address - Phone:903-757-7871
Practice Address - Fax:903-753-2479
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL3632208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150512506Medicaid
TX150512504Medicaid
TXH57100Medicare UPIN