Provider Demographics
NPI:1932111903
Name:EDWARDS, JENNIFER L (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 GASTON AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2031
Mailing Address - Country:US
Mailing Address - Phone:214-823-4800
Mailing Address - Fax:214-823-4801
Practice Address - Street 1:3417 GASTON AVE STE 700
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2031
Practice Address - Country:US
Practice Address - Phone:214-823-4800
Practice Address - Fax:214-823-4801
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7775207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046191501Medicaid
TX87X762OtherBCBS
TX87X762Medicare PIN
TX046191501Medicaid
TX990008154Medicare PIN