Provider Demographics
NPI:1841516218
Name:EDWARDS, RANDI LEIGH (MD)
Entity type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:LEIGH
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:RANDI
Other - Middle Name:LEIGH
Other - Last Name:KROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 W. IRONWOOD DRIVE
Mailing Address - Street 2:SUITE 155
Mailing Address - City:COEUR D'ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2666
Mailing Address - Country:US
Mailing Address - Phone:208-667-0585
Mailing Address - Fax:208-667-0876
Practice Address - Street 1:700 W. IRONWOOD DRIVE
Practice Address - Street 2:SUITE 155
Practice Address - City:COEUR D'ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2666
Practice Address - Country:US
Practice Address - Phone:208-667-0585
Practice Address - Fax:208-667-0876
Is Sole Proprietor?:No
Enumeration Date:2010-04-10
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-11849208000000X
WAMD60621797208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics