Provider Demographics
NPI:1114949922
Name:VERDE, EDWARD W (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:W
Last Name:VERDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EDWARD
Other - Middle Name:
Other - Last Name:VERDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3055 FLOYD AVENUE, #353
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355
Mailing Address - Country:US
Mailing Address - Phone:909-522-4322
Mailing Address - Fax:
Practice Address - Street 1:1441 FLORIDA AVENUE
Practice Address - Street 2:CARDIOVASCULAR ANESTHESIOLOGY
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95352
Practice Address - Country:US
Practice Address - Phone:209-578-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68621207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A686210Medicaid
H97382Medicare UPIN
CA00A686210Medicaid