Provider Demographics
NPI:1861458069
Name:EDWARDS, FRANK DAMON (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:DAMON
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 1:2001 MALL DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2560
Mailing Address - Country:US
Mailing Address - Phone:903-336-3412
Mailing Address - Fax:
Practice Address - Street 1:2001 MALL DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2560
Practice Address - Country:US
Practice Address - Phone:903-336-3412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-1822207PE0004X
TXQ7863207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR134953001Medicaid
AR134953001Medicaid
ARG75230Medicare UPIN