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Individual

DR. JEFFERSON R. EDWARDS III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
14540 OLD SAINT AUGUSTINE RD, SUITE 2571, JACKSONVILLE, FL 32258-7418
(904) 886-2251
(904) 886-7151
Mailing address
11945 SAN JOSE BLVD, BLDG 300, JACKSONVILLE, FL 32223-1627
(904) 396-1725
(904) 399-1717

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME61528
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
020034505
RAILROAD MEDICARE
01
14861
BCBS FL
01
227864
AVMED
01
2683030
CIGNA
01
4236497
AETNA
Enumeration date
05/02/2006
Last updated
06/15/2011
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