Provider Demographics
NPI:1750313441
Name:EDWARDS, LEO K (MD)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:K
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2011 E HOUSTON ST
Mailing Address - Street 2:SUITE 104C
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78202-2916
Mailing Address - Country:US
Mailing Address - Phone:210-225-5047
Mailing Address - Fax:210-225-7951
Practice Address - Street 1:2011 E HOUSTON ST
Practice Address - Street 2:SUITE 104C
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78202-2916
Practice Address - Country:US
Practice Address - Phone:210-225-5047
Practice Address - Fax:210-225-7951
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1524207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035375701Medicaid
TXC15439Medicare UPIN
TX00PP09Medicare ID - Type Unspecified