Provider Demographics
NPI:1740283084
Name:JONES-POLAND, EDITH ANN (MD)
Entity type:Individual
Prefix:DR
First Name:EDITH
Middle Name:ANN
Last Name:JONES-POLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73345 HIGHWAY 111 STE 101
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-3909
Mailing Address - Country:US
Mailing Address - Phone:760-773-4948
Mailing Address - Fax:760-773-4910
Practice Address - Street 1:73345 HIGHWAY 111 STE 101
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3909
Practice Address - Country:US
Practice Address - Phone:760-773-4948
Practice Address - Fax:760-773-4910
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76482208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A764820Medicaid
CAH56245Medicare UPIN
CA00A764823Medicare PIN