Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 34713 | KY |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | M12737 | ID |
NPI | 1013977297 |
---|---|
Provider Name | Edward R Setser |
First Address | Atlanta, GA 30384-7381 |
Second Address | Idaho Falls, ID 83404-7586 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 30/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000023797 | BCBS MOUNTAIN STATE (01) | WV |
0129142000 | (05) | WV |
0289272 | (05) | OH |
030028200 | BLACK LUNG (01) | WV |
550357050 | UNITED MINE WORKERS (01) | WV |
64942469 | (05) | KY |
G01007 | (02) | WV |