Individual
ADAM DEAN EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAA
Contact information
Practice address
615 S NEW BALLAS RD DEPT OF, SAINT LOUIS, MO 63141
(636) 386-9224
(636) 386-7679
Mailing address
339 CONSORT DR, BALLWIN, MO 63011-4439
(636) 386-9224
(636) 386-7679
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
75000155A
IN
367H00000X
Anesthesiologist Assistant
111
SC
367H00000X
Anesthesiologist Assistant
Primary
2018016968
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1102312995
ANTHEM PTAN
IN
Enumeration date
03/28/2018
Last updated
12/03/2024
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