Provider Demographics
NPI:1447439229
Name:THOMAS L EDWARDS DO INC
Entity type:Organization
Organization Name:THOMAS L EDWARDS DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-588-0476
Mailing Address - Street 1:12844 JOE HARIG ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:FL
Mailing Address - Zip Code:33576
Mailing Address - Country:US
Mailing Address - Phone:352-588-0476
Mailing Address - Fax:888-523-3008
Practice Address - Street 1:12844 JOE HARIG ROAD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:FL
Practice Address - Zip Code:33576
Practice Address - Country:US
Practice Address - Phone:352-588-0476
Practice Address - Fax:888-523-3008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370860800Medicaid
FLAI777Medicare PIN
FL370860800Medicaid