Provider Demographics
NPI:1922117894
Name:EDWARDS, KEITH C (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:C
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 1:200 W. ARBOR DR.
Mailing Address - Street 2:UCSD MEDICAL CENTER, RADIOLOGY
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-8756
Mailing Address - Country:US
Mailing Address - Phone:619-471-9451
Mailing Address - Fax:
Practice Address - Street 1:9300 CAMPUS POINT DR.
Practice Address - Street 2:UCSD THORNTON HOSPITAL RADIOLOGY
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-7756
Practice Address - Country:US
Practice Address - Phone:619-471-9451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG332902085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1922117894Medicaid
CA00G332900OtherBS OF CA
CA00G332900OtherBS OF CA
CA1922117894Medicaid