Provider Demographics
NPI:1568704450
Name:EDMAN, GARY J (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:J
Last Name:EDMAN
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4705 N FEDERAL HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496
Mailing Address - Country:US
Mailing Address - Phone:561-405-9610
Mailing Address - Fax:561-218-0210
Practice Address - Street 1:4705 N FEDERAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496
Practice Address - Country:US
Practice Address - Phone:561-405-9610
Practice Address - Fax:561-218-0210
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106103363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant