Provider Demographics
NPI:1245295864
Name:EADES, EDWARD (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:EADES
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 1:2940 N SWAN RD
Mailing Address - Street 2:#130
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712
Mailing Address - Country:US
Mailing Address - Phone:520-323-6994
Mailing Address - Fax:520-733-0787
Practice Address - Street 1:2940 N SWAN RD
Practice Address - Street 2:130
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5601
Practice Address - Country:US
Practice Address - Phone:520-323-6994
Practice Address - Fax:520-733-0787
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19656208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMD19656OtherMEDICARE ID
AZB22433Medicare UPIN