Provider Demographics
NPI:1285667766
Name:EDWIN R ALEXANDER MD INC
Entity Type:Organization
Organization Name:EDWIN R ALEXANDER MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-550-7575
Mailing Address - Street 1:1140 W LA VETA AVE.
Mailing Address - Street 2:SUITE 540
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4227
Mailing Address - Country:US
Mailing Address - Phone:714-550-7575
Mailing Address - Fax:714-550-7550
Practice Address - Street 1:1140 W LA VETA AVE
Practice Address - Street 2:SUITE 540
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4223
Practice Address - Country:US
Practice Address - Phone:714-550-7575
Practice Address - Fax:714-550-7550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74683207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA74683Medicare UPIN