Basic Information
| Provider Information | |||||||||
| NPI: | 1407893035 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | EDWARDS | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1589 CAMPBELL DR | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257052915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045259131 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2561 THIRD AVENUE | ||||||||
| Address2: | PEDIATRIC PLASTIC SURGERY/CRANIOFACIAL C | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 02570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045259131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0122X | 209508 | MA | Y | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery |
No ID Information.