Provider Demographics
NPI:1114124153
Name:STRONG, EDWARD BRADLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:BRADLEY
Last Name:STRONG
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 1:2521 STOCKTON BLVD STE 7200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2207
Mailing Address - Country:US
Mailing Address - Phone:916-734-8064
Mailing Address - Fax:916-703-5011
Practice Address - Street 1:2521 STOCKTON BLVD STE 7200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2207
Practice Address - Country:US
Practice Address - Phone:916-734-8064
Practice Address - Fax:916-703-5011
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG82263207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G622630Medicaid
CA00G822630Medicare PIN
CA00G622630Medicaid