Provider Demographics
NPI:1366736159
Name:EDGERTON, JOSHUA KENNETH (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:KENNETH
Last Name:EDGERTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36258
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-1204
Mailing Address - Country:US
Mailing Address - Phone:251-318-2678
Mailing Address - Fax:251-405-9900
Practice Address - Street 1:6701 AIRPORT BLVD STE A208
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3763
Practice Address - Country:US
Practice Address - Phone:251-266-3544
Practice Address - Fax:251-266-3543
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-01821208600000X
ALMD.49740208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery