Individual
DOMINICK EDISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
403 E 15TH ST, AUSTIN, TX 78701-1437
(512) 804-3335
Mailing address
1430 COLLIER ST, AUSTIN, TX 78704-2911
(512) 472-4357
(512) 703-1394
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
984059
TX
Other
Enumeration date
07/09/2020
Last updated
07/09/2020
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