Provider Demographics
NPI:1861680548
Name:EDWARDS, ROBERT BUSTER JR (ED D)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BUSTER
Last Name:EDWARDS
Suffix:JR
Gender:M
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 3RD ST NE
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-2477
Mailing Address - Country:US
Mailing Address - Phone:701-852-0315
Mailing Address - Fax:701-852-3645
Practice Address - Street 1:1000 3RD ST NE
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-2477
Practice Address - Country:US
Practice Address - Phone:701-852-0315
Practice Address - Fax:701-852-3645
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional