Provider Demographics
NPI:1053404871
Name:EDWARDS, DAVID FRANKLIN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:FRANKLIN
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 1:744 S WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3505
Mailing Address - Country:US
Mailing Address - Phone:920-445-7226
Mailing Address - Fax:920-445-7229
Practice Address - Street 1:3263 EATON RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6830
Practice Address - Country:US
Practice Address - Phone:920-433-6000
Practice Address - Fax:920-433-6009
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 84855207P00000X
ALMD.31095207P00000X
TN38726207PE0004X, 207P00000X, 207Q00000X
VA0101057916207P00000X
WI64847-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00364636OtherRAILROAD MEDICARE
KY64088636Medicaid
VA010256623Medicaid
TN3897971Medicaid
KY000000361786OtherBCBS
TN4089353OtherBCBS
TNP00364636OtherRAILROAD MEDICARE
TNH63658Medicare UPIN
KY64088636Medicaid