Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | MD007832 | LA |
NPI | 1639401656 |
---|---|
Provider Name | Edward Bruce Edrington |
First Address | Metairie, LA 70005 |
Second Address | Metairie, LA 70005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2010 |
Last Update Date | 01/02/2010 |