Individual
STEVEN RAY EDMONDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3025 N TARRANT PKWY, SUITE 240, FORT WORTH, TX 76177-8620
(817) 431-1500
Mailing address
3025 N TARRANT PKWY, SUITE 240, FORT WORTH, TX 76177-8620
(817) 431-1500
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
G8830
TX
207VG0400X
Gynecology Physician
G8830
TX
207VX0000X
Obstetrics Physician
G8830
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0737147
UNITED HEALTHCARE
TX
05
—
109380901
—
TX
05
—
131769502
—
TX
05
—
131769508
—
TX
05
—
131769509
—
TX
05
—
131769510
—
TX
01
—
2357545
AETNA
TX
01
—
83022Y
BLUE CROSS BLUE SHIELD
TX
Enumeration date
07/07/2005
Last updated
10/15/2016
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