Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | OS-0006349 | FL |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | OS6349 | FL |
NPI | 1205879459 |
---|---|
Provider Name | Dr. Thomas Lloyd Edwards |
First Address | San Antonio, FL 33576-0537 |
Second Address | San Antonio, FL 33576-0537 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 04/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
370860800 | (05) | FL |
56339 | AOA NUMBER (01) | FL |
BE3211733 | DEA REGISTRATION NUMBER (01) | FL |
F30891 | (02) | FL |
OS-0006349 | OSTEOPATHIC LICENSE (01) | FL |