Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | MD012286E | PA |
NPI | 1043590318 |
---|---|
Provider Name | Dr. Edward Michael Overfield |
First Address | Erie, PA 16508-2787 |
Second Address | Erie, PA 16508-2787 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2011 |
Last Update Date | 18/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B36444 | (02) | PA |