Provider Demographics
NPI:1336454214
Name:N.B. EDGERTON, JR., M.D., P.A.
Entity Type:Organization
Organization Name:N.B. EDGERTON, JR., M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:EDGERTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:813-875-8650
Mailing Address - Street 1:2706 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6360
Mailing Address - Country:US
Mailing Address - Phone:813-875-8650
Mailing Address - Fax:
Practice Address - Street 1:4510 W BAY TO BAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-6537
Practice Address - Country:US
Practice Address - Phone:813-875-8650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0027671207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty