Provider Demographics
NPI:1750610226
Name:EDWARDS, STEVEN MAX (LAC)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:MAX
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:7310 CROSSBOW TRL
Mailing Address - Street 2:
Mailing Address - City:LAGO VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78645-4742
Mailing Address - Country:US
Mailing Address - Phone:512-267-2661
Mailing Address - Fax:
Practice Address - Street 1:3410 FAR WEST BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3194
Practice Address - Country:US
Practice Address - Phone:512-342-9125
Practice Address - Fax:512-342-9126
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-13
Last Update Date:2009-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01166171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist