Individual
JERRY L EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3412 STAUNTON AVE SE, CHARLESTON, WV 25304-1327
(304) 388-6004
(304) 388-3360
Mailing address
3412 STAUNTON AVE SE, CHARLESTON, WV 25304-1327
(304) 388-6004
(304) 388-3360
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
851
WV
207P00000X
Emergency Medicine Physician
DO1265
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3305715
—
TN
01
—
4078407
BCBS PROVIDER
—
01
—
930077458
RAILROAD MEDICARE
—
Enumeration date
01/26/2006
Last updated
10/19/2018
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