Provider Demographics
NPI:1093716771
Name:SANDOVAL, EDGAR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W 41ST ST STE 406
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3647
Mailing Address - Country:US
Mailing Address - Phone:305-534-2986
Mailing Address - Fax:305-534-0462
Practice Address - Street 1:301 W 41ST ST STE 406
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3647
Practice Address - Country:US
Practice Address - Phone:305-534-2986
Practice Address - Fax:305-534-0462
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59750208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology