Provider Demographics
NPI:1285609891
Name:EDWARDS, FRED HAYDEN (MD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:HAYDEN
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3660
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:UFJP SURGERY DEPT
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-3418
Practice Address - Fax:904-244-6347
Is Sole Proprietor?:No
Enumeration Date:2006-02-18
Last Update Date:2007-12-02
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Provider Licenses
StateLicense IDTaxonomies
FLME67811208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC89101Medicare UPIN
FL18913ZMedicare PIN