Provider Demographics
NPI:1710921119
Name:EDWARDS, JEFFREY L (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:EDWARDS
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:P.O. BOX 45771
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68145-0771
Mailing Address - Country:US
Mailing Address - Phone:402-894-9990
Mailing Address - Fax:402-884-0129
Practice Address - Street 1:10020 NICHOLAS ST
Practice Address - Street 2:STE 106
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2189
Practice Address - Country:US
Practice Address - Phone:402-894-9990
Practice Address - Fax:402-884-0129
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16977207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine