Provider Demographics
NPI:1942899133
Name:DAVID G EDWARDS D P M P C
Entity Type:Organization
Organization Name:DAVID G EDWARDS D P M P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:801-619-2175
Mailing Address - Street 1:PO BOX 404
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-0404
Mailing Address - Country:US
Mailing Address - Phone:801-619-2175
Mailing Address - Fax:877-428-7520
Practice Address - Street 1:550 E 1400 N STE Y
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2407
Practice Address - Country:US
Practice Address - Phone:435-757-6542
Practice Address - Fax:800-507-1652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty