Provider Demographics
NPI:1720363831
Name:EDWARDS, KEVIN JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:JOSEPH
Last Name:EDWARDS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 NE 1ST AVE APT 1903
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3663
Mailing Address - Country:US
Mailing Address - Phone:304-584-3538
Mailing Address - Fax:
Practice Address - Street 1:3635 NE 1ST AVE APT 1903
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3663
Practice Address - Country:US
Practice Address - Phone:304-584-3538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY60608207P00000X
FL119327207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine