Individual
HARRISON B EDGLEY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5176 HILL RD E, LAKEPORT, CA 95453-6300
(888) 453-6625
(818) 550-0909
Mailing address
PO BOX 951, GLENDALE, CA 91209-0951
(818) 550-0900
(818) 550-0909
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A50453
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A504530
—
CA
01
—
A50453
LICENSE
CA
Enumeration date
01/03/2007
Last updated
07/09/2007
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