Individual
DR. TIMOTHY EDELBLUTE
Active
Individual
DR. TIMOTHY EDELBLUTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD20678
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
150406
MARION POLK CHP
—
05
—
150406
—
OR
05
—
8363673
—
WA
01
—
A045
CHAMPUS
—
01
—
G57684
GROUP HEALTH
—
05
—
XPY198713
—
CA
Enumeration date
08/16/2006
Last updated
12/04/2007
Update your record
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