Organization
MORNING STAR FAMILY MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWIN FUENTES D.O. (PHYSICIAN)
(434) 791-0306
Entity
Organization
Contact information
Practice address
109 DEER RUN RD, DANVILLE, VA 24540-2863
(434) 791-0306
(434) 791-0310
Mailing address
109 DEER RUN RD, DANVILLE, VA 24540-2863
(434) 791-0306
(434) 791-0310
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
49D0965836
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005641870
—
VA
Enumeration date
05/01/2006
Last updated
11/30/2015
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