Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | R7C16 | MO |
NPI | 1083708986 |
---|---|
Provider Name | Thomas E Edes |
First Address | Washington, DC 20420-0001 |
Second Address | Washington, DC 20422-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 20/03/2013 |