Active NPI
Larry Edmondson, MD
- Family Medicine Physician
- Austin, TX
National Provider Identifier
1689753824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- L4828
- Practice address
- 7800 Shoal Creek Blvd
Ste 130W
Austin, TX 78757-1098 - Phone
- (713) 874-0012
- Fax
- (713) 532-5756
- NPI assigned
- Nov 6, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | L4828 | TX | Primary |
Addresses
Primary practice location
7800 Shoal Creek Blvd
Ste 130W
Austin, TX 78757-1098
Mailing address
PO Box 1239
Troy, MI 48099-1239
Phone (248) 824-6600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404950400000",
"number": "1689753824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1239",
"city": "TROY",
"state": "MI",
"postal_code": "480991239",
"telephone_number": "248-824-6600",
"fax_number": "855-618-6655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7800 SHOAL CREEK BLVD",
"address_2": "STE 130W",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787571098",
"telephone_number": "713-874-0012",
"fax_number": "713-532-5756"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDMONDSON",
"first_name": "LARRY",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-06",
"last_updated": "2014-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "L4828",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.