Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 32998 | TX |
Y | 213EG0000X | General Practice | 32998 | TX |
NPI | 1003336405 |
---|---|
Provider Name | Joel Christopher Edgar |
First Address | Spring, TX 77379-7456 |
Second Address | Spring, TX 77379-7456 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2017 |
Last Update Date | 27/06/2017 |