Provider Demographics
NPI:1811905938
Name:EDWARDS, WILLIAM M (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 KUENZLI ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1117
Mailing Address - Country:US
Mailing Address - Phone:775-329-5162
Mailing Address - Fax:775-334-4359
Practice Address - Street 1:1715 KUENZLI STREET
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502
Practice Address - Country:US
Practice Address - Phone:775-329-5162
Practice Address - Fax:775-334-4359
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14951208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD0696Medicaid
AKMD0696Medicaid
AKH58456Medicare UPIN
AK8EZ16DMedicare ID - Type Unspecified