Provider Demographics
NPI:1215258371
Name:VERCELES, EDWARD JR (DO)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:VERCELES
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 SAINT GERMAIN LN
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-1135
Mailing Address - Country:US
Mailing Address - Phone:530-400-2463
Mailing Address - Fax:
Practice Address - Street 1:411 30TH ST STE 314
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3312
Practice Address - Country:US
Practice Address - Phone:530-400-2463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12997208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice