Provider Demographics
NPI:1962459545
Name:LAW, EDWARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:LAW
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 N. SUNRISE AVE.
Mailing Address - Street 2:SUITE 1409
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661
Mailing Address - Country:US
Mailing Address - Phone:916-783-0496
Mailing Address - Fax:916-783-9406
Practice Address - Street 1:151 N SUNRISE AVE STE 1409
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2934
Practice Address - Country:US
Practice Address - Phone:916-783-0496
Practice Address - Fax:916-783-9406
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4079213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU69342Medicare UPIN
CA000E40790Medicare PIN
CA4247820001Medicare NSC