Provider Demographics
NPI:1477961225
Name:EDMOND, JAMES EDWARD JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EDWARD
Last Name:EDMOND
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:4600 S MILL AVE
Mailing Address - Street 2:STE 280
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-6850
Mailing Address - Country:US
Mailing Address - Phone:480-305-2888
Mailing Address - Fax:480-305-2889
Practice Address - Street 1:287 E HUNT HWY
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-5095
Practice Address - Country:US
Practice Address - Phone:480-677-8282
Practice Address - Fax:480-677-8283
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2017-04-05
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Provider Licenses
StateLicense IDTaxonomies
MN11580363AM0700X
AZ6653363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1059048OtherNCCPA