Individual
JERRY V EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
6410 FANNIN ST, 1020, HOUSTON, TX 77030-3000
(832) 325-7090
Mailing address
PO BOX 201088, HOUSTON, TX 77216-1088
(713) 500-3500
(713) 512-2238
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA00354
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
183223001
—
TX
01
—
87N145
BCBS
TX
Enumeration date
06/14/2006
Last updated
12/03/2007
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