Individual
DR. MARK T EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
455 SAINT MICHAELS DR, SANTA FE, NM 87505-7601
(505) 983-3361
Mailing address
PO BOX 2505, SALEM, OR 97308-2505
(888) 828-3197
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2005-0068
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10017799
LOVELACE
—
01
—
14924
PRESBYTERIAN
—
05
—
28186354
—
NM
01
—
85-0236178-024
MOLINA HEALTHCARE
—
01
—
85-0236178-032
MOLINA HEALTHCARE SALUD
—
Enumeration date
06/28/2006
Last updated
10/05/2007
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