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NPI Code Detail

MEDICARE: ROBERT H EDMUND M.D.

MEDICARE: ROBERT H EDMUND M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianG28789CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ZZZ92073ZOTHERCAMEDICARE GROUP ID#
3ZZZ91892ZOTHERCAMEDICARE GROUP ID#
4ZZZ92069ZOTHERCAMEDICARE GROUP ID#
5ZZZ91891ZOTHERCAMEDICARE GROUP ID#

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2G28789OTHERCAMEDICAL LICENSE#

General Provider Information

NPI Number : 1689618183
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT H EDMUND M.D.
Provider Business Mailing Address
First Line : 1400 EMELINE AVE
Second Line :
City : SANTA CRUZ
State : CA
Zip : 95060-1976
Country : US
Telephone Number : 831-454-4170
Fax Number : 831-454-4663
Provider Business Practice Location Address
First Line : 12 W BEACH ST
Second Line :
City : WATSONVILLE
State : CA
Zip : 95076-4504
Country : US
Telephone Number : 831-454-4170
Fax Number : 831-454-4663
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2006
Last Update Date : 03/07/2023

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