Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2016013259 | MO |
Y | 208000000X | Pediatrician | R3502 | TX |
N | 2080P0204X | Pediatric Emergency Doctor | 2016013259 | MO |
NPI | 1215379987 |
---|---|
Provider Name | Dr. Colleen D Edge |
First Address | Dallas, TX 75231-4242 |
Second Address | Dallas, TX 75231-4242 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2013 |
Last Update Date | 02/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ENROLLED | (05) | IL |