Provider Demographics
NPI:1780824466
Name:EDWARD G. STOKES, MD, INC.
Entity Type:Organization
Organization Name:EDWARD G. STOKES, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-888-2210
Mailing Address - Street 1:155 W HOSPITALITY LN
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3305
Mailing Address - Country:US
Mailing Address - Phone:909-888-2210
Mailing Address - Fax:909-885-5818
Practice Address - Street 1:155 W HOSPITALITY LN
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3305
Practice Address - Country:US
Practice Address - Phone:909-888-2210
Practice Address - Fax:909-885-5818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25145174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty