Provider Demographics
NPI:1952507675
Name:EDWARDS, ELIOT WESLEY (ND)
Entity Type:Individual
Prefix:DR
First Name:ELIOT
Middle Name:WESLEY
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 NE 7TH AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3998
Mailing Address - Country:US
Mailing Address - Phone:503-206-6218
Mailing Address - Fax:888-972-1720
Practice Address - Street 1:1836 NE 7TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212
Practice Address - Country:US
Practice Address - Phone:503-206-6218
Practice Address - Fax:888-972-1720
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4049175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR4049OtherOR NATUROPATHIC PHYSICIAN LICENSE #4049