Provider Demographics
NPI:1780744524
Name:EDWARDS, TED LEROY JR (MD)
Entity type:Individual
Prefix:DR
First Name:TED
Middle Name:LEROY
Last Name:EDWARDS
Suffix:JR
Gender:
Credentials:MD
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Mailing Address - Street 1:4201 BEE CAVE RD
Mailing Address - Street 2:B112
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6465
Mailing Address - Country:US
Mailing Address - Phone:512-327-4886
Mailing Address - Fax:512-327-4958
Practice Address - Street 1:4201 BEE CAVE RD
Practice Address - Street 2:B112
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6465
Practice Address - Country:US
Practice Address - Phone:512-327-4886
Practice Address - Fax:512-327-4958
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2025-04-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXC8269207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB103938OtherMEDICARE PTAN