Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | MD00028212 | WA |
NPI | 1538398524 |
---|---|
Provider Name | J. Michael Edwards |
First Address | Friday Harbor, WA 98250-9417 |
Second Address | Friday Harbor, WA 98250-9417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2009 |
Last Update Date | 10/07/2009 |