Individual
DR. JASON NATHANIEL EDMONDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1684 N PROSPECT AVE, MILWAUKEE, WI 53202-2408
(414) 271-2020
Mailing address
1684 N PROSPECT AVE, MILWAUKEE, WI 53202-2408
(414) 271-2020
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
53925-20
WI
207W00000X
Ophthalmology Physician
8236057-1205
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/24/2008
Last updated
05/02/2013
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