Provider Demographics
NPI:1144323098
Name:EDWARDS, GREGSON STANSFIELD (DPM)
Entity type:Individual
Prefix:DR
First Name:GREGSON
Middle Name:STANSFIELD
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2814 BOCA CHICA BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-3504
Mailing Address - Country:US
Mailing Address - Phone:956-546-3338
Mailing Address - Fax:
Practice Address - Street 1:2814 BOCA CHICA BLVD.
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521
Practice Address - Country:US
Practice Address - Phone:956-546-3338
Practice Address - Fax:956-542-1606
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX840213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT13127Medicare UPIN