Individual
MR. ERIC LEE EDWARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
523 MOUNT ST, GREENFIELD, IN 46140-2420
(317) 654-0455
Mailing address
523 MOUNT ST, GREENFIELD, IN 46140-2420
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200999470
—
IN
Enumeration date
12/20/2010
Last updated
12/20/2010
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