Theodore E. Edis

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

0101018288 Issued in VA

Practice address

400 Eagleton Cove Way
Palm Beach Gardens, FL 33418-8456

Phone

(561) 775-1981

NPI assigned

Mar 19, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275657561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 EAGLETON COVE WAY",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334188456",
            "telephone_number": "561-775-1981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 EAGLETON COVE WAY",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334188456",
            "telephone_number": "561-775-1981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDIS",
        "first_name": "THEODORE",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "VA",
            "license": "0101018288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Palm Beach Gardens, FL
• Providers in Palm Beach Gardens, FL by specialty
• Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.