Individual
FRED EDWARDS III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
23343 W ASHLEIGH MARIE DR, BUCKEYE, AZ 85326-6290
(619) 871-4401
Mailing address
23343 W ASHLEIGH MARIE DR, BUCKEYE, AZ 85326-6290
(619) 871-4401
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
10294
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
964058
—
AZ
Enumeration date
01/22/2007
Last updated
07/09/2007
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