Provider Demographics
NPI:1013910215
Name:EDWARDS, BETTY J (MD)
Entity Type:Individual
Prefix:DR
First Name:BETTY
Middle Name:J
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 1:13438 BELHAVEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069
Mailing Address - Country:US
Mailing Address - Phone:281-621-0132
Mailing Address - Fax:
Practice Address - Street 1:10130 LOUETTA RD
Practice Address - Street 2:STE G
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-2116
Practice Address - Country:US
Practice Address - Phone:281-440-4089
Practice Address - Fax:832-698-5316
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2007-09-19
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
TXE6072174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC15436Medicare UPIN
TXRW41Medicare ID - Type UnspecifiedMEDICARE PROVIDER