Provider Demographics
NPI:1487624557
Name:EDWARDS, DEAN A (MD)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:A
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:477 KENSINGTON LN
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-8428
Mailing Address - Country:US
Mailing Address - Phone:573-334-4969
Mailing Address - Fax:573-334-7340
Practice Address - Street 1:1429 N MOUNT AUBURN RD
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-2171
Practice Address - Country:US
Practice Address - Phone:573-334-8870
Practice Address - Fax:573-388-2310
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD105287207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO206977506Medicaid
MO009011310Medicare ID - Type Unspecified
MO206977506Medicaid