Individual ProviderRicky D EdwardsFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address1223 S Main St, Fort Worth, TX 76104-4804(817) 702-7314PECOS EnrollmentBased on the most recent information from CMS, provider Ricky D Edwards does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1457358699Provider TypeIndividualFull NameEdwards, Ricky DCredentialMDGenderMaleSole ProprietorNoEnumeration Date7/1/2005Last Updated12/4/2012Contact InformationPractice LocationPractice Address1223 S Main St, Fort Worth, TX 76104-4804Phone(817) 702-7314Fax(817) 702-7315Mailing LocationMailing Address1223 S Main St, Fort Worth, TX 76104-4804Phone(817) 702-7314Fax(817) 702-7315Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseE8450TexasProvider IdentifiersIDDescriptionIssuerID1285553-05DescriptionMedicaidIssuerUnlistedTexas