Individual
DANIEL EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
(765) 448-8000
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
57011491
OH
2085R0204X
Vascular & Interventional Radiology Physician
Primary
01070685A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000766888
ANTHEM PROVIDER NUMBER
IN
05
—
201022560
—
IN
Enumeration date
10/17/2007
Last updated
02/02/2021
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