Organization
DUWAYNE P. EDGE, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DUWAYNE PAUL EDGE D.O. (PRESIDENT)
(361) 775-0961
Entity
Organization
Contact information
Practice address
2605 AMARILLO, INGLESIDE, TX 78362-5710
(361) 775-0961
(361) 775-0960
Mailing address
P.O. BOX 1507, INGLESIDE, TX 78362-1507
(361) 775-0961
(361) 775-0960
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
J6416
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101248603
—
TX
Enumeration date
06/22/2010
Last updated
06/22/2010
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