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General NPI Number Information
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NPI Number | 1538042957
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Entity Type | Individual
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Provider Name | BARON EDMONSON
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Gender | Male
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Dates
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Enumeration Date | 07/31/2025
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Last Update Date | 02/23/2026
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Provider Practice Location Address
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Address Line | 4881 SUGAR MAPLE DR, WRIGHT-PATTERSON AFB,
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City | APO
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State | AA
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Zip | 45433
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Country | US
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Telephone | 937-731-3880
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Fax |
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Provider Business Mailing Address
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Address Line | 5050 CONERSTONE N BLVD APT 2409
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City | CENTERVILLE
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State | OH
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Zip | 45440
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Country | US
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Telephone |
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 14235425-9926
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License Number State | UT
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