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General NPI Number Information
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NPI Number | 1679540702
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Entity Type | Individual
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Provider Name | MARK JOSEPH EDMUNDS D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 1610 S MAIN ST STE. 9
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-1974
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Country | US
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Telephone | 270-885-1203
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Fax | 270-885-1561
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Provider Business Mailing Address
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Address Line | 1610 S MAIN ST STE. 9
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-1974
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Country | US
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Telephone | 270-885-1203
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Fax | 270-885-1561
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 00294
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License Number State | KY
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