Healthcare Provider Details

I. General information

NPI: 1366736159
Provider Name (Legal Business Name): JOSHUA KENNETH EDGERTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 AIRPORT BLVD STE A208
MOBILE AL
36608-3763
US

IV. Provider business mailing address

PO BOX 36258
BELFAST ME
04915-1204
US

V. Phone/Fax

Practice location:
  • Phone: 251-266-3544
  • Fax: 251-266-3543
Mailing address:
  • Phone: 251-318-2678
  • Fax: 251-405-9900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2016-01821
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD.49740
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: