Provider Demographics
NPI:1124262365
Name:KOHLER-EDWARDS, DAVID E (IDMT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:E
Last Name:KOHLER-EDWARDS
Suffix:
Gender:M
Credentials:IDMT
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Mailing Address - Street 1:1670 E. PERIMETER WAY
Mailing Address - Street 2:162ND MEDICAL GROUP/ARIZONA AIR NATIONAL GUARD
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706
Mailing Address - Country:US
Mailing Address - Phone:520-295-6172
Mailing Address - Fax:520-295-6658
Practice Address - Street 1:1670 E. PERIMETER WAY
Practice Address - Street 2:162ND MEDICAL GROUP/ARIZONA AIR NATIONAL GUARD
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706
Practice Address - Country:US
Practice Address - Phone:520-295-6172
Practice Address - Fax:520-295-6658
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
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Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians