Provider Demographics
NPI:1386632909
Name:EDGERTON, JAMES R (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:EDGERTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4708 ALLIANCE BLVD
Mailing Address - Street 2:BLDG. 1, SUITE 700
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5340
Mailing Address - Country:US
Mailing Address - Phone:972-596-6676
Mailing Address - Fax:972-596-7078
Practice Address - Street 1:4708 ALLIANCE BLVD
Practice Address - Street 2:BLDG. 1, SUITE 700
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5340
Practice Address - Country:US
Practice Address - Phone:972-596-6676
Practice Address - Fax:972-596-7078
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6572208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX039024704Medicaid
TX039024705Medicaid
TX039024704Medicaid
TXTXB113988Medicare PIN
B84816Medicare UPIN
TXP00927065Medicare PIN