Provider Demographics
NPI:1245859347
Name:EDWARDS, JORDON PALMER (DO)
Entity type:Individual
Prefix:
First Name:JORDON
Middle Name:PALMER
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BADGERS HLS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1374
Mailing Address - Country:US
Mailing Address - Phone:801-669-1734
Mailing Address - Fax:
Practice Address - Street 1:3440 N CENTER STREET, SUITE 800
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043
Practice Address - Country:US
Practice Address - Phone:801-990-1911
Practice Address - Fax:801-990-1912
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
UT13700886-1204207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program