Provider Demographics
NPI:1801152152
Name:EDWARDS, JEFFREY DARREN (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DARREN
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1198
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79604-1198
Mailing Address - Country:US
Mailing Address - Phone:253-076-2263
Mailing Address - Fax:325-307-6288
Practice Address - Street 1:5302 BUFFALO GAP ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606
Practice Address - Country:US
Practice Address - Phone:325-307-6226
Practice Address - Fax:325-307-6288
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10043538207R00000X
TXP9187207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBP10043538OtherPHYSICIAN-IN-TRAINING PERMIT FROM TEXAS MEDICAL BOARD