Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | G8830 | TX |
N | 207VG0400X | Gynecologist | G8830 | TX |
N | 207VX0000X | Obstetrician | G8830 | TX |
NPI | 1164429890 |
---|---|
Provider Name | Steven Ray Edmondson |
First Address | Fort Worth, TX 76177-8620 |
Second Address | Fort Worth, TX 76177-8620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 15/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0737147 | UNITED HEALTHCARE (01) | TX |
109380901 | (05) | TX |
131769502 | (05) | TX |
131769508 | (05) | TX |
131769509 | (05) | TX |
131769510 | (05) | TX |
2357545 | AETNA (01) | TX |
83022Y | BLUE CROSS BLUE SHIELD (01) | TX |
C15418 | (02) | TX |