Provider Demographics
NPI:1871564708
Name:EDWARDS, WILLIAM BENJAMIN (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BENJAMIN
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1802 E 50TH STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79404
Mailing Address - Country:US
Mailing Address - Phone:806-771-1160
Mailing Address - Fax:806-771-1162
Practice Address - Street 1:1802 E 50TH STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79404
Practice Address - Country:US
Practice Address - Phone:806-771-1160
Practice Address - Fax:806-771-1162
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL7364207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM15778291Medicaid
TX166359304Medicaid
TX182156301Medicaid
TXI03331Medicare UPIN
00W580Medicare PIN
TX166359304Medicaid