Provider Demographics
NPI:1023082542
Name:EDWARDS, ROBERT L (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 HUNTERS RUN
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-8171
Mailing Address - Country:US
Mailing Address - Phone:318-728-9988
Mailing Address - Fax:318-728-9977
Practice Address - Street 1:553 HUNTERS RUN
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-8171
Practice Address - Country:US
Practice Address - Phone:318-539-1028
Practice Address - Fax:318-539-1072
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA178202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
15680OtherLA CDS
AR128050001Medicaid
LA1348627Medicaid
LA1348627Medicaid
15680OtherLA CDS
AR128050001Medicaid