Provider Demographics
NPI:1851853436
Name:EDWARDS, KANE ETHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KANE
Middle Name:ETHAN
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:PO BOX 21595
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4112
Mailing Address - Country:US
Mailing Address - Phone:251-300-5941
Mailing Address - Fax:
Practice Address - Street 1:75 S UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3271
Practice Address - Country:US
Practice Address - Phone:251-471-7872
Practice Address - Fax:251-460-7923
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-3764207R00000X, 207RG0100X
ALMD.44540207RG0100X, 207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program