| Doctor Name: | MR. JAMES EDWARD EDMOND |
| NPI Number: | 1477961225 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | 11580 |
| Business Practice Address: | 2300 County Road 29 Fci Sandstone, Health Services Sandstone, MN - 550725161 |
| Business Phone Number: | 3202452262 |
| Business Fax Number: | 3202456695 |
| Mailing Address: | 2300 County Road 29, Fci Sandstone, Health Services SANDSTONE |
| State: | MN |
| Postal Code: | 550725161 |
| Phone Number: | 3202452262 |
| Fax Number: | 3202456695 |
| NPI Enumeration Date: | 07/24/2014 |
| NPI Last Update Date: | 07/24/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 11580 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |