Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2120 | ME |
NPI | 1134310618 |
---|---|
Provider Name | Dr. Garrett B Edwards |
First Address | Saco, ME 04072-1543 |
Second Address | Saco, ME 04072-1543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2007 |
Last Update Date | 26/10/2009 |