Individual
DR. TODD BRIAN EDMISTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1711 N MCKENZIE ST, FOLEY, AL 36535-2249
(251) 476-5050
(251) 450-2770
Mailing address
PO BOX 86144, MOBILE, AL 36689-6144
(251) 476-5050
(251) 450-2770
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
25804
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121148
—
AL
01
—
528700580
MEDICAID GROUP
—
Enumeration date
10/11/2006
Last updated
11/11/2013
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