Provider Demographics
NPI:1003087891
Name:PAGET, EDWARD THURSTON (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:THURSTON
Last Name:PAGET
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 1:2005 CARTY WAY
Mailing Address - Street 2:
Mailing Address - City:NEEDLES
Mailing Address - State:CA
Mailing Address - Zip Code:92363-3053
Mailing Address - Country:US
Mailing Address - Phone:760-326-0083
Mailing Address - Fax:760-326-6311
Practice Address - Street 1:1600 BAILEY AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:NEEDLES
Practice Address - State:CA
Practice Address - Zip Code:92363-3105
Practice Address - Country:US
Practice Address - Phone:760-326-0083
Practice Address - Fax:760-326-6311
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12373208600000X, 208D00000X
CAG-16009208D00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU146AMedicare PIN