Individual
LAURIE EDMISTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7777 FOREST LN, DALLAS, TX 75232
(972) 566-5544
(214) 369-5457
Mailing address
6206 PRESTONSHIRE LN, DALLAS, TX 75225-2109
(214) 891-0511
(214) 369-5457
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G5015
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
P000L34W4
—
TX
Enumeration date
03/19/2007
Last updated
07/08/2007
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