# EDWARD GWIN M.D., LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639359250
- **Authorized official:** DR. EDWARD GWIN M.D. (OWNER)
- **Authorized official phone:** (417) 883-0487

## Contact information

- **Practice address:** 1342 E PRIMROSE ST, SPRINGFIELD, MO 65804-4279
- **Practice address phone:** (417) 886-2747
- **Practice address fax:** (417) 886-2774
- **Mailing address:** 2527 E MELBOURNE RD, SPRINGFIELD, MO 65804-5208

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RS0012X | Sleep Medicine (Internal Medicine) Physician | R5222 | MO | Yes |
| 261Q00000X | Clinic/Center | R5222 | MO | — |

## Other

- **Enumeration date:** 11/12/2007
- **Last updated:** 11/12/2007