Provider Demographics
NPI:1588129530
Name:JORDAN W. EDWARDS, MD, LTD
Entity type:Organization
Organization Name:JORDAN W. EDWARDS, MD, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-409-9500
Mailing Address - Street 1:770 SANDOVAL RD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-5671
Mailing Address - Country:US
Mailing Address - Phone:775-430-7417
Mailing Address - Fax:775-376-9963
Practice Address - Street 1:1351 CORPORATE BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-7102
Practice Address - Country:US
Practice Address - Phone:775-409-9500
Practice Address - Fax:775-376-9963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1154613677OtherNPI