Provider Demographics
NPI:1225329840
Name:ERIDON, JAMIE M (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:M
Last Name:ERIDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2888 LONG BEACH BLVD, STE. 165
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806
Mailing Address - Country:US
Mailing Address - Phone:657-241-9052
Mailing Address - Fax:714-665-4663
Practice Address - Street 1:2888 LONG BEACH BLVD, STE. 165
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806
Practice Address - Country:US
Practice Address - Phone:657-241-9052
Practice Address - Fax:714-665-4663
Is Sole Proprietor?:No
Enumeration Date:2011-04-30
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA183854208600000X, 208G00000X
IL036.139626208600000X
MEMD23038208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery