Provider Demographics
NPI:1285801548
Name:EDWARDS, LARRY A
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:A
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 MARKET ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3451
Mailing Address - Country:US
Mailing Address - Phone:530-713-4305
Mailing Address - Fax:530-674-5994
Practice Address - Street 1:1190 MARKET ST
Practice Address - Street 2:SUITE D
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3451
Practice Address - Country:US
Practice Address - Phone:530-713-4305
Practice Address - Fax:530-674-5994
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies