Provider Demographics
NPI:1902887193
Name:EDWARDS, BYRON CLYDE (PA-C, PHD)
Entity Type:Individual
Prefix:MR
First Name:BYRON
Middle Name:CLYDE
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PA-C, PHD
Other - Prefix:
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Mailing Address - Street 1:257 W 400 S
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-1760
Mailing Address - Country:US
Mailing Address - Phone:801-224-5639
Mailing Address - Fax:801-224-2667
Practice Address - Street 1:1385 E 750 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-5480
Practice Address - Country:US
Practice Address - Phone:801-224-5200
Practice Address - Fax:801-224-2667
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0057862002Medicare ID - Type Unspecified