Provider Demographics
NPI:1851491096
Name:REDER, EDWARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:A
Last Name:REDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1625 E MAIN ST
Mailing Address - Street 2:STE. 100
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-5211
Mailing Address - Country:US
Mailing Address - Phone:619-442-9896
Mailing Address - Fax:619-442-2245
Practice Address - Street 1:1625 E MAIN ST
Practice Address - Street 2:STE. 100
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-5211
Practice Address - Country:US
Practice Address - Phone:619-442-9896
Practice Address - Fax:619-442-2245
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC34975207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWC34975AMedicare ID - Type Unspecified
CAA35792Medicare UPIN