Provider Demographics
NPI:1114909728
Name:EDGERTON, NORMAN BRUCE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:BRUCE
Last Name:EDGERTON
Suffix:JR
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 1:2706 W DR MARTIN LUTHER KING BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607
Mailing Address - Country:US
Mailing Address - Phone:813-875-8650
Mailing Address - Fax:
Practice Address - Street 1:2706 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:STE A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6360
Practice Address - Country:US
Practice Address - Phone:813-875-8650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0027671207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037059200Medicaid
FL037059200Medicaid
D62130Medicare UPIN