Provider Demographics
NPI:1881604387
Name:EDWARDS, MICHAEL CHARLES JR (DPM)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHARLES
Last Name:EDWARDS
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1084 RIBAUT RD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5494
Mailing Address - Country:US
Mailing Address - Phone:843-524-0232
Mailing Address - Fax:843-524-3323
Practice Address - Street 1:1084 RIBAUT RD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5494
Practice Address - Country:US
Practice Address - Phone:843-524-0232
Practice Address - Fax:843-524-3323
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC129213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0169920001OtherMEDICARE DURABLE MEDICAL
SCPD1297Medicaid
SCPD1297Medicaid
U53371Medicare UPIN
48002843Medicare ID - Type UnspecifiedRR MEDICARE