Provider Demographics
NPI:1659315752
Name:ALEXANDER, EDWIN R (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:R
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EDWIN
Other - Middle Name:R
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1140 W LA VETA AVE
Mailing Address - Street 2:
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:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4227
Practice Address - Country:US
Practice Address - Phone:714-550-7575
Practice Address - Fax:714-550-7550
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74683207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA74683Medicare ID - Type Unspecified