Individual
TIMOTHY DWIGHT EDMISTEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
965 STATE FARM RD, BOONE, NC 28607-4948
(828) 264-2340
(828) 262-0731
Mailing address
965 STATE FARM RD, BOONE, NC 28607-4948
(828) 264-2340
(828) 262-0731
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
9800856
NC
2086S0129X
Vascular Surgery Physician
9800856
NC
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
9800856
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891227R
—
NC
Enumeration date
09/20/2005
Last updated
03/10/2023
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