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Individual

TERENCE SHAUN EDGAR

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1821 S WEBSTER AVE, GREEN BAY, WI 54301-2253
(920) 496-4700
Mailing address
PO BOX 19070, GREEN BAY, WI 54307-9070
(920) 496-4700

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
34917-20
WI
2084E0001X
Epilepsy Physician
34917-20
WI
2084N0008X
Neuromuscular Medicine (Psychiatry & Neurology) Physician
34917-20
WI
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
34917-20
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
32117600
WI
05
ENROLLED
IA
05
ENROLLED
MN
Enumeration date
07/09/2006
Last updated
08/28/2025
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