Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DN20067 | FL |
N | 1223E0200X | Endodontist | DRP 547 | FL |
NPI | 1043410491 |
---|---|
Provider Name | Mitchell R Edlund |
First Address | Sarasota, FL 34239 |
Second Address | Sarasota, FL 34239 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2007 |
Last Update Date | 30/10/2014 |