Provider Demographics
NPI:1316907876
Name:EDWARDS, STANLEY OWEN (MD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:OWEN
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7251 W 20TH ST
Mailing Address - Street 2:UNIT K
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4625
Mailing Address - Country:US
Mailing Address - Phone:970-353-4322
Mailing Address - Fax:970-353-0190
Practice Address - Street 1:7251 W 20TH ST
Practice Address - Street 2:UNIT K
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4625
Practice Address - Country:US
Practice Address - Phone:970-353-4322
Practice Address - Fax:970-353-0190
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19391207R00000X, 173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01193911Medicaid
COED30586OtherBCBS
D23600Medicare UPIN
COC802589Medicare PIN