Provider Demographics
NPI:1053421248
Name:EDWARDS, JOHN N (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:N
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 1:6785 WEAVER RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-8055
Mailing Address - Country:US
Mailing Address - Phone:815-633-8545
Mailing Address - Fax:
Practice Address - Street 1:6785 WEAVER RD
Practice Address - Street 2:SUITE D
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-8055
Practice Address - Country:US
Practice Address - Phone:815-633-8545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology