Provider Demographics
NPI:1790833481
Name:EDWARDS, CHAD P (DO)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:P
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12142 S YUKON AVE
Mailing Address - Street 2:
Mailing Address - City:GLENPOOL
Mailing Address - State:OK
Mailing Address - Zip Code:74033-6621
Mailing Address - Country:US
Mailing Address - Phone:918-935-3636
Mailing Address - Fax:918-296-7934
Practice Address - Street 1:12142 S YUKON AVE
Practice Address - Street 2:
Practice Address - City:GLENPOOL
Practice Address - State:OK
Practice Address - Zip Code:74033
Practice Address - Country:US
Practice Address - Phone:918-935-3636
Practice Address - Fax:918-296-7934
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03124207P00000X
OK4353207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine