Individual
MARK S EDMISTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1600 SW ARCHER RD, GAINESVILLE, FL 32610-3003
(352) 273-6575
(352) 392-7029
Mailing address
PO BOX 918025, ORLANDO, FL 32891-8025
(352) 273-6575
(352) 392-7029
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
30600
CO
207L00000X
Anesthesiology Physician
Primary
ME0039555
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001583400
—
FL
05
—
01306000
—
CO
05
—
790403
—
AZ
05
—
T0645
—
UT
05
—
X9058
—
NM
Enumeration date
01/10/2007
Last updated
02/16/2010
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