Provider Demographics
NPI:1710234315
Name:EDWARDS, ANGELA (DPM)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:905 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-4037
Mailing Address - Country:US
Mailing Address - Phone:575-543-7200
Mailing Address - Fax:575-543-7209
Practice Address - Street 1:905 S 8TH ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-4037
Practice Address - Country:US
Practice Address - Phone:575-543-7200
Practice Address - Fax:575-543-7209
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2160213ES0103X
NM383213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM481015YRCAMedicare PIN