Provider Demographics
NPI:1871988972
Name:EDWARDS, JEFFREY BRYANT (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:BRYANT
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N CATTLEMEN RD STE 220
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6422
Mailing Address - Country:US
Mailing Address - Phone:419-371-6565
Mailing Address - Fax:941-377-7731
Practice Address - Street 1:600 N CATTLEMEN RD STE 220
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6422
Practice Address - Country:US
Practice Address - Phone:941-371-6565
Practice Address - Fax:941-377-7731
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1325182086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110761000Medicaid