Provider Demographics
NPI:1346339322
Name:EDWARDS, RODNEY DARWIN JR (MD)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:DARWIN
Last Name:EDWARDS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1173 GARRISON DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-1023
Mailing Address - Country:US
Mailing Address - Phone:904-287-1053
Mailing Address - Fax:904-287-1053
Practice Address - Street 1:507 E 19TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGBURG
Practice Address - State:IN
Practice Address - Zip Code:47542-9388
Practice Address - Country:US
Practice Address - Phone:812-683-4717
Practice Address - Fax:812-683-4764
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01028294A207P00000X
FLME 90997207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100337600Medicaid
KY6487655000Medicaid
KY6487655000Medicaid
E03910Medicare UPIN
IN137600QQMedicare PIN