Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 10943 | WV |
NPI | 1134132418 |
---|---|
Provider Name | Edmundo E. Figueroa |
First Address | Charleston, WV 25301-1853 |
Second Address | Charleston, WV 25301-1853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 20/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0129115000 | (05) | WV |
D49251 | (02) | WV |