Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | WVEDU | WV |
NPI | 1336638295 |
---|---|
Provider Name | Dr. Edward Mark Edris |
First Address | Lewisburg, WV 24901 |
Second Address | Lewisburg, WV 24901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2018 |
Last Update Date | 07/05/2018 |