Individual provider · Type 1 NPI

Jacob Stafford Edmisson, MD

Student in an Organized Health Care Education/Training Program · Indianapolis, IN

NPI number 1609444967 Active

Practice location

535 Barnhill Dr
Indianapolis, IN 46202-5116

Call (317) 948-6942 Map

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000X11023782A (IN)
Internal Medicine Physician 207R00000X2021021803 (MO)

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1609444967

Jacob Stafford Edmisson, MD's National Provider Identifier is 1609444967, issued on Jun 14, 2021. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Indianapolis, IN. The record was last updated on Jun 18, 2024.