Provider Demographics
NPI:1770558298
Name:EDWARDS, RONALD JONATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JONATHAN
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:631 SW HORNE ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1663
Mailing Address - Country:US
Mailing Address - Phone:785-783-4571
Mailing Address - Fax:785-783-4572
Practice Address - Street 1:631 SW HORNE ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1694
Practice Address - Country:US
Practice Address - Phone:785-783-4571
Practice Address - Fax:785-783-4572
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-19
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS 04-28283207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100347380 FMedicaid
KS105109Medicare ID - Type Unspecified
KS100347380 FMedicaid