Provider Demographics
NPI:1548342157
Name:EDMONDS, HARVEY LAWRENCE (MD)
Entity type:Individual
Prefix:
First Name:HARVEY
Middle Name:LAWRENCE
Last Name:EDMONDS
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 1:728 E BULLARD AVENUE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710
Mailing Address - Country:US
Mailing Address - Phone:559-436-9800
Mailing Address - Fax:559-436-9804
Practice Address - Street 1:728 E BULLARD AVENUE
Practice Address - Street 2:SUITE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710
Practice Address - Country:US
Practice Address - Phone:559-436-9800
Practice Address - Fax:559-436-9804
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG247252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G247250OtherMEDICAL PROV NO
CA4136936OtherMEDICAL UPIN
CA4136936OtherMEDICAL UPIN
CA00G247250OtherMEDICAL PROV NO