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General NPI Number Information
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NPI Number | 1124079033
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Entity Type | Individual
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Provider Name | DAVID A EDMONDSON DO
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Gender | Male
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 04/13/2020
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Provider Practice Location Address
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Address Line | 512 S 28TH AVE
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City | WAUSAU
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State | WI
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Zip | 54401-4147
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Country | US
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Telephone | 715-847-2021
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Fax | 715-847-2325
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Provider Business Mailing Address
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Address Line | 512 S 28TH AVE
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City | WAUSAU
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State | WI
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Zip | 54401-4147
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Country | US
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Telephone | 715-847-2021
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Fax | 715-847-2325
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | 45109
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207KI0005X
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Taxonomy Name | Clinical & Laboratory Immunology (Allergy & Immunology) Physician
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License Number | 45109
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License Number State | WI
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