Provider Demographics
NPI:1780799940
Name:BIEDERMAN, EDWARD B
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:B
Last Name:BIEDERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 N FEDERAL HWY
Mailing Address - Street 2:SUITE A-27
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4608
Mailing Address - Country:US
Mailing Address - Phone:954-938-9966
Mailing Address - Fax:954-938-8227
Practice Address - Street 1:4701 N FEDERAL HWY
Practice Address - Street 2:SUITE A-27
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4608
Practice Address - Country:US
Practice Address - Phone:954-938-9966
Practice Address - Fax:954-938-8227
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME26835207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261626200Medicaid
FLD82618Medicare UPIN
FL261626200Medicaid