Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | NT 00000391 | WA |
NPI | 1073858684 |
---|---|
Provider Name | Dr. Edward Joseph Madison SR. |
First Address | Mill Creek, WA 98082-0545 |
Second Address | Mukilteo, WA 98275-3229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2012 |
Last Update Date | 07/12/2012 |