Individual
JOHNATHAN J EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
301 MEMORIAL MEDICAL PKWY, DAYTONA BEACH, FL 32117-5167
(386) 231-3072
(386) 231-5962
Mailing address
5300 S ATLANTIC AVE APT 19602, NEW SMYRNA BEACH, FL 32169-7522
(702) 222-3238
(702) 221-2231
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
10500
NV
207L00000X
Anesthesiology Physician
Primary
ME119864
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100504572
—
NV
Enumeration date
03/09/2006
Last updated
11/21/2024
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