Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 14000 | MS |
Y | 207V00000X | Obstetrician & Gynecologist | ME75682 | FL |
NPI | 1003802935 |
---|---|
Provider Name | Dr. Deborah J. Edgeworth |
First Address | Pensacola, FL 32513-2699 |
Second Address | Panama City Beach, FL 32407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2005 |
Last Update Date | 21/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
255106300 | (05) | FL |
G85469 | (02) | FL |