Individual
KIRT LEE EDLY
Active
Individual
KIRT LEE EDLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA21381
CA
363AS0400X
Surgical Physician Assistant
PA21381
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA21381
CALIFORNIA LICENSE
CA
Enumeration date
07/11/2008
Last updated
04/05/2023
Update your record
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