Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 45109 | WI |
NPI | 1124079033 |
---|---|
Provider Name | Dr. David A Edmondson |
First Address | Wausau, WI 54401-4147 |
Second Address | Wausau, WI 54401-4147 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 13/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
008906261N | HUMANA (01) |