Individual
EVERTON ANTHONY EDMONDSON
Active
Individual
EVERTON ANTHONY EDMONDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
G9451
TX
208VP0014X
Interventional Pain Medicine Physician
G9451
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
139241712
—
TX
05
—
139241716
—
TX
05
—
139241717
—
TX
01
—
8AJ445
BLUE CROSS
TX
Enumeration date
01/03/2006
Last updated
11/13/2020
Update your record
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