Individual
ALYSON ELAINE EDMUNDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
100 MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-3645
Mailing address
PO BOX 413021, SALT LAKE CITY, UT 84141-3021
(801) 213-3900
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
0101246455
VA
208000000X
Pediatrics Physician
Primary
344720-1205
UT
390200000X
Student in an Organized Health Care Education/Training Program
0116019749
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306043682
—
VA
Enumeration date
06/29/2007
Last updated
11/03/2014
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