Provider Demographics
NPI:1306122163
Name:EDWARDS, PAUL S (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1050 MARTIN LUTHER KING DRIVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801
Mailing Address - Country:US
Mailing Address - Phone:618-532-3517
Mailing Address - Fax:618-532-0801
Practice Address - Street 1:1050 MARTIN LUTHER KING DRIVE
Practice Address - Street 2:SUITE 108
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801
Practice Address - Country:US
Practice Address - Phone:618-532-3517
Practice Address - Fax:618-532-0801
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036129055207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease