Provider Demographics
NPI:1619193745
Name:EDISON, RICHARD BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BRUCE
Last Name:EDISON
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 1:3109 STIRLING RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-6558
Mailing Address - Country:US
Mailing Address - Phone:954-981-3223
Mailing Address - Fax:954-964-2719
Practice Address - Street 1:3109 STIRLING RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6558
Practice Address - Country:US
Practice Address - Phone:954-981-3223
Practice Address - Fax:954-964-2719
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME442402086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery