DR. EDWARD PAUL SOUTHERN (NPI# 1053360941) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053360941 |
| Entity Type | Individual |
| Full Name | DR. EDWARD PAUL SOUTHERN |
| Credential | M.D. |
| Practice Address |
307 Boatner Rd Ste 114 Eglin Afb FL 32542-1302 |
| Practice Telephone | 8508838345 |
| Mailing Telephone | 8508838345 |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2018-12-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207X00000X | Orthopaedic Surgery | C050274 | CA | Allopathic & Osteopathic Physicians |
| Y | 207XS0117X |
Orthopaedic Surgery Specialization: Orthopaedic Surgery of the Spine |
C050274 | CA | Allopathic & Osteopathic Physicians |
| N | 207XP3100X |
Orthopaedic Surgery Specialization: Pediatric Orthopaedic Surgery |
C050274 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | BS4496724 | DEA | 01 |
| LA | 2301209 | 05 | |
| LA | DEA | BS4496724 | 01 |
| Street Address |
307 BOATNER RD STE 114 |
| City | EGLIN AFB |
| State | FL |
| Zip Code | 32542-1302 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134111453 | Thomas James Cantilina | Family Medicine | 307 Boatner Rd Ste 114, Eglin Afb, FL 32542-1302 | 2005-08-23 |
| 1861009466 | Patricia Allison Kellogg | Dietitian, Registered | 307 Boatner Rd Ste 114, Eglin Afb, FL 32542-1302 | 2020-09-28 |
| 1396367389 | Matthew Christopher Little | Student in an Organized Health Care Education/Training Program | 307 Boatner Rd Ste 114, Eglin Afb, FL 32542-1302 | 2020-05-12 |
| 1750916961 | Joseph Roland Adamson | Student in an Organized Health Care Education/Training Program | 307 Boatner Rd Ste 114, Eglin Afb, FL 32542-1302 | 2020-03-08 |
| 1447885181 | Deserea Marie Shoemaker | Student in an Organized Health Care Education/Training Program | 307 Boatner Rd Ste 114, Eglin Afb, FL 32542-1282 | 2020-03-03 |
| 1457985764 | Anaya Baeza | Nurse Practitioner | 307 Boatner Rd Ste 114, Eglin Afb, FL 32542-1302 | 2020-02-25 |
| 1043853435 | Sandra K Hoffa | Social Worker | 307 Boatner Rd Ste 114, Eglin Afb, FL 32542-1302 | 2019-10-18 |
| 1861042624 | Amy W Snow | Pharmacist | 307 Boatner Rd Ste 114, Eglin Afb, FL 32542-1302 | 2019-09-13 |
| 1760042501 | Alison Natalie Snyder | Student in an Organized Health Care Education/Training Program | 307 Boatner Rd Ste 114, Eglin Afb, FL 32542-1302 | 2019-06-14 |
| 1689237232 | Clint Copeland | Physical Therapist | 307 Boatner Rd Ste 114, Eglin Afb, FL 32542-1302 | 2019-04-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417440306 | Colt Sicher | Student in an Organized Health Care Education/Training Program | 96th Dental Squadron (afmc), Eglin Afb, Fl 32542, Apo, AA 32542 | 2018-06-14 |
| 1841679529 | Matthew Scurria | Dentist | 340 Boatner Rd. Bldg 2751, 96 Dental Squadron/sgdr, Eglin Afb, FL 32542 | 2015-05-27 |
| 1134518798 | 96th Medical Support Squadron | Military/U.S. Coast Guard Pharmacy | 3120 A. Talon Way, Eglin Afb Fld #3, FL 32542 | 2015-01-20 |
| 1598177123 | 96th Medical Support Squadron | Military/U.S. Coast Guard Pharmacy | 96 Medical Group Satellite Phcy Memorial Trail, Bldg. 1758, Eglin Afb, FL 32542 | 2014-06-02 |
| 1548602923 | Gerald Jordan Novack | Psychologist | 96mdos/sgow, 307 Boatner Rd, Fpo, AP 32542 | 2013-07-25 |
| 1699112821 | Taylor Anne Hahn | Obstetrics & Gynecology | 96th Medical Group, 307 Boatner Road, Eglin Air Force Base, FL 32542 | 2013-05-29 |
| 1730456948 | Nicholas Brandon Sager | Dentist | 340 Boatner Rd, Eglin Afb, Apo, AA 32542 | 2011-11-17 |
| 1134402662 | Jessamy Jae Thornton | Student in an Organized Health Care Education/Training Program | 340 Boatner Rd, Bldg 2751, Eglin Afb, FL 32542 | 2011-09-21 |
| 1346523974 | Mary Elizabeth Sorrentino | Dentist | 340 Boatner Road, Blgd. 2751, Eglin Afb, FL 32542 | 2011-09-20 |
| 1588945612 | Martin Army Community Hospital | Clinic/Center | 4327 North El Salvador Way, Eglin Afb, FL 32542 | 2011-09-02 |
| Find all providers in zip 32542 | ||||
| Taxonomy Code | 207XS0117X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Orthopaedic Surgery of the Spine |
| Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic surgeons of the spine deal with the evaluation and nonoperative and operative treatment of the full spectrum of primary spinal disorders including trauma, degenerative, deformity, tumor, and reconstructive. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Separate board certification is not currently offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689654345 | John Thomas Friedland | Orthopaedic Surgery | 307 Boatner Rd Ste 114, Eglin Afb, FL 32542-1302 | 2006-01-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386293215 | Citrus Spine Institute LLC | Orthopaedic Surgery | 1409 Kingsley Ave Ste 9f, Orange Park, FL 32073-4579 | 2019-09-04 |
| 1194383638 | Ortho Florida, LLC | Orthopaedic Surgery | 8190 S Jog Rd Ste 101, Boynton Beach, FL 33472-2911 | 2019-05-30 |
| 1821571175 | Orthopedic Spine Solutions Corp | Orthopaedic Surgery | 3852 Sheridan St, Hollywood, FL 33021-3634 | 2018-09-12 |
| 1194223461 | Select Health of Fl, LLC | Orthopaedic Surgery | 2 S Biscayne Blvd Ste 3760a, Miami, FL 33131-1815 | 2018-01-31 |
| 1568960839 | Spine Cin of Jacksonville LLC | Orthopaedic Surgery | 1301 Riverplace Blvd Ste 800a, Jacksonville, FL 32207-9047 | 2018-01-31 |
| 1912405283 | Spine Cin of Naples LLC | Orthopaedic Surgery | 8831 Business Park Dr Ste 301a, Fort Myers, FL 33912-2510 | 2018-01-31 |
| 1386142644 | Joint Replacement Cin of Naples LLC | Orthopaedic Surgery | 8831 Business Park Dr Ste 301b, Fort Myers, FL 33912-2510 | 2018-01-31 |
| 1366940140 | Joint Replacement Cin of Orlando LLC | Orthopaedic Surgery | 5401 S Kirkman Rd Ste 310b, Orlando, FL 32819-7940 | 2018-01-26 |
| 1811495690 | Joint Replacement Cin of Miami LLC | Orthopaedic Surgery | 2 S Biscayne Blvd Ste 3760b, Miami, FL 33131-1815 | 2018-01-26 |
| 1689182362 | Fss Keys LLC | Orthopaedic Surgery | 1111 12th St Ste 108, Key West, FL 33040-4087 | 2018-01-17 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.