Provider Demographics
NPI:1780216929
Name:EDWARDS, RODERICK LEE II
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:LEE
Last Name:EDWARDS
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5724 BENSON DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70812-2603
Mailing Address - Country:US
Mailing Address - Phone:225-371-4203
Mailing Address - Fax:
Practice Address - Street 1:5724 BENSON DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70812-2603
Practice Address - Country:US
Practice Address - Phone:225-371-4203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver