Provider Demographics
NPI:1982832572
Name:EDWARDS, JAMIE RYAN (DO)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:RYAN
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 161180
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-1180
Mailing Address - Country:US
Mailing Address - Phone:904-388-6949
Mailing Address - Fax:904-388-1841
Practice Address - Street 1:1 SHIRCLIFF WAY DEPT OF
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4748
Practice Address - Country:US
Practice Address - Phone:904-388-6949
Practice Address - Fax:904-388-1841
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2023-11-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS136842085R0202X, 2085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology