Individual
MR. EDGAR TATING VICTORIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1411 PIEDMONT CUTOFF, GADSDEN, AL 35903
(256) 492-0131
Mailing address
P.O. BOX 97, GADSDEN, AL 35902
(256) 492-0131
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
00007957
AL
208600000X
Surgery Physician
Primary
7957
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000046490
—
AL
05
—
009923940
—
AL
05
—
100906
—
AL
05
—
143752 (WADLEY)
—
AL
05
—
143754 (ANNISTON)
—
AL
05
—
143836 (CLEBURNE)
—
AL
05
—
143995 (COMPLEX)
—
AL
01
—
51046490
BLUE CROSS
AL
01
—
51094372
BLUECROSS
AL
01
—
630736845
IRS TAXPER IDENTIFICATION
AL
Enumeration date
08/19/2006
Last updated
03/25/2013
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