Provider Demographics
NPI:1972731271
Name:EDWARDS, BRIAN PHILLIP (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PHILLIP
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:440 RAYNOLDS ST # 51015
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-1613
Mailing Address - Country:US
Mailing Address - Phone:915-215-4477
Mailing Address - Fax:915-215-5386
Practice Address - Street 1:4815 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905
Practice Address - Country:US
Practice Address - Phone:915-521-7621
Practice Address - Fax:915-521-7849
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2018-09-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301094599207R00000X, 208M00000X
TXR8182207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30630851Medicare PIN