Basic Information
| Provider Information | |||||||||
| NPI: | 1053404871 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDWARDS | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | FRANKLIN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 744 S WEBSTER AVE | ||||||||
| Address2: | |||||||||
| City: | GREEN BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 543013505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9204457226 | ||||||||
| FaxNumber: | 9204457229 | ||||||||
| Practice Location | |||||||||
| Address1: | 3263 EATON RD | ||||||||
| Address2: | |||||||||
| City: | GREEN BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 543116830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9204336000 | ||||||||
| FaxNumber: | 9204336009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 09/11/2019 | ||||||||
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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 | 207P00000X | ME 84855 | FL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD.31095 | AL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207PE0004X | 38726 | TN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | 207P00000X | 38726 | TN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 0101057916 | VA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 38726 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 64847-20 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00364636 | 01 | TN | RAILROAD MEDICARE | OTHER | 64088636 | 05 | KY | MEDICAID | 010256623 | 05 | VA | MEDICAID | 3897971 | 05 | TN | MEDICAID | 000000361786 | 01 | KY | BCBS | OTHER | 4089353 | 01 | TN | BCBS | OTHER |