# LISA EDGERTON DO PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366615254
- **Authorized official:** DR. LISA M EDGERTON D.O. (PRESIDENT)
- **Authorized official phone:** (786) 390-8684

## Contact information

- **Practice address:** 114 NE 107TH ST, MIAMI SHORES, FL 33161-7032
- **Practice address phone:** (786) 390-8684
- **Practice address fax:** (305) 654-5270
- **Mailing address:** 114 NE 107TH ST, MIAMI SHORES, FL 33161-7032
- **Mailing address phone:** (786) 390-8684
- **Mailing address fax:** (305) 654-5270

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | OS 8636 | FL | Yes |

## Other

- **Enumeration date:** 04/11/2008
- **Last updated:** 04/11/2008