Provider Demographics
NPI:1902038375
Name:EDWARDS, MARJORIE ANTENOR (MD)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ANTENOR
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 W PERSIMMON ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3359
Mailing Address - Country:US
Mailing Address - Phone:479-636-7192
Mailing Address - Fax:479-631-8212
Practice Address - Street 1:1615 W PERSIMMON ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3359
Practice Address - Country:US
Practice Address - Phone:479-636-7192
Practice Address - Fax:479-631-8212
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014015316207P00000X, 207Q00000X
ARE-7010207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine