Provider Demographics
NPI:1235170028
Name:FELIX, EDWARD LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LAWRENCE
Last Name:FELIX
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 1:504 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6917
Mailing Address - Country:US
Mailing Address - Phone:805-332-8446
Mailing Address - Fax:805-332-8173
Practice Address - Street 1:316 SOUTH STRATFORD AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5908
Practice Address - Country:US
Practice Address - Phone:805-332-8446
Practice Address - Fax:805-332-8173
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43375208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB216479OtherMEDICARE ID
CAA49326Medicare UPIN