Duwayne P. Edge, P.a.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

J6416 Issued in TX

Legal business name

DUWAYNE P. EDGE, P.A.

Practice address

2605 Amarillo
Ingleside, TX 78362-5710

Phone

(361) 775-0961

Fax

(361) 775-0960

NPI assigned

Jun 22, 2010

Last updated

Jun 22, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Duwayne Paul Edge, D.O.NPI 1730152612

Title

President

Phone

(361) 775-0961

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Duwayne Paul Edge, D.O.

  • Family Medicine Physician
  • Ingleside, TX
  • NPI 1730152612
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1277164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277164800000",
    "number": "1235450404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 1507",
            "city": "INGLESIDE",
            "state": "TX",
            "postal_code": "783621507",
            "telephone_number": "361-775-0961",
            "fax_number": "361-775-0960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2605 AMARILLO",
            "city": "INGLESIDE",
            "state": "TX",
            "postal_code": "783625710",
            "telephone_number": "361-775-0961",
            "fax_number": "361-775-0960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUWAYNE P. EDGE, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-22",
        "last_updated": "2010-06-22",
        "status": "A",
        "authorized_official_last_name": "EDGE",
        "authorized_official_first_name": "DUWAYNE",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "361-775-0961",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "J6416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101248603",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Steven Castro, MD
• Candice Cleghorn, NP
• Carlee R Cole, PH.D., LPC, NCC
• Norman Crabb II, DO
• Dhanvis Health Care-2, LLC (Jays Pharmacy Ingleside)
• Duwayne Paul Edge, D.O.
• Roy Michael Elias
• Elizabeth Elmore
• Faithful Modalities Medical Massage LLC
• Jason Paul Fechner, IDC

• Family Medicine Physician in Ingleside, TX
• Providers in Ingleside, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.