Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | DO1606 | AL |
NPI | 1114290525 |
---|---|
Provider Name | Joseph Lee Edison |
First Address | Auburn, AL 36849-0001 |
Second Address | Auburn, AL 36849-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2012 |
Last Update Date | 28/03/2017 |