Basic Information
| Provider Information | |||||||||
| NPI: | 1285698530 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDWARDS | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | JUSTIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 OAKFIELD DR | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335115700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136842229 | ||||||||
| FaxNumber: | 8138130330 | ||||||||
| Practice Location | |||||||||
| Address1: | 505 OAKFIELD DR | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335115700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136842229 | ||||||||
| FaxNumber: | 8138130330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2006 | ||||||||
| LastUpdateDate: | 12/31/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | ME68617 | FL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | ME68617 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 022971300 | 05 | FL | MEDICAID |