Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | ME11646 | FL |
NPI | 1720031438 |
---|---|
Provider Name | Dr. Lewis James Edgemon |
First Address | Sanford, FL 32771-3646 |
Second Address | Orlando, FL 32803-8208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 08/07/2007 |