Basic Information
| Provider Information | |||||||||
| NPI: | 1679745590 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EDWARDS | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3340 E GOLDSTONE WAY | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836421026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083675171 | ||||||||
| FaxNumber: | 5058205408 | ||||||||
| Practice Location | |||||||||
| Address1: | 1055 N CURTIS ROAD | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083672121 | ||||||||
| FaxNumber: | 5058205408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2008 | ||||||||
| LastUpdateDate: | 12/06/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | MD2010-0534 | NM | N | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 207QA0505X | M-12213 | ID | Y | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 208M00000X | 036.129296 | IL | N | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.