Provider Demographics
NPI:1588692446
Name:EDWARDS, WILSON BARTON JR (MD)
Entity type:Individual
Prefix:
First Name:WILSON
Middle Name:BARTON
Last Name:EDWARDS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1607 LISENBY AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3796
Mailing Address - Country:US
Mailing Address - Phone:850-250-3360
Mailing Address - Fax:850-640-3798
Practice Address - Street 1:1607 LISENBY AVE
Practice Address - Street 2:SUITE D
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3796
Practice Address - Country:US
Practice Address - Phone:850-250-3360
Practice Address - Fax:850-640-3798
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME652882084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275982900Medicaid
FLF87728Medicare UPIN