Individual
DR. LISA MARIE EDGERTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
114 NE 107TH ST, MIAMI SHORES, FL 33161-7032
(786) 390-8684
(305) 654-5270
Mailing address
114 NE 107TH ST, MIAMI SHORES, FL 33161-7032
(786) 390-8684
(305) 654-5270
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
OS 8636
FL
207R00000X
Internal Medicine Physician
5101013599
MI
208M00000X
Hospitalist Physician
Primary
5101013599
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2647761 00
—
FL
Enumeration date
09/26/2006
Last updated
09/04/2020
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