Provider Demographics
NPI:1770572281
Name:EDWARDS, BILL (DO)
Entity type:Individual
Prefix:DR
First Name:BILL
Middle Name:
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 1:1705 RENAISSANCE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3041
Mailing Address - Country:US
Mailing Address - Phone:405-285-7500
Mailing Address - Fax:405-285-7501
Practice Address - Street 1:13420 N PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9007
Practice Address - Country:US
Practice Address - Phone:405-478-0633
Practice Address - Fax:405-478-5218
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2365207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$Medicare PIN
OKE73272Medicare UPIN