Individual
DR. JACOB STAFFORD EDMISSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
535 BARNHILL DR, INDIANAPOLIS, IN 46202-5116
(317) 948-6942
Mailing address
535 BARNHILL DR, INDIANAPOLIS, IN 46202-5116
(317) 948-6942
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2021021803
MO
390200000X
Student in an Organized Health Care Education/Training Program
Primary
11023782A
IN
Other
Enumeration date
06/14/2021
Last updated
06/18/2024
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