Provider Demographics
NPI:1821011974
Name:EDMOND, JIMMY (MD)
Entity type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:
Last Name:EDMOND
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:PO BOX 3189
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34611-3189
Mailing Address - Country:US
Mailing Address - Phone:352-666-0790
Mailing Address - Fax:352-666-0903
Practice Address - Street 1:7539 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4350
Practice Address - Country:US
Practice Address - Phone:352-666-0790
Practice Address - Fax:352-666-0903
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81127207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G78647Medicare UPIN
FLE5364YMedicare ID - Type Unspecified