Provider Demographics
NPI:1790986735
Name:HIRSCH, EDWARD ALAN (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:ALAN
Last Name:HIRSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 TRAIL VIEW PL
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-6663
Mailing Address - Country:US
Mailing Address - Phone:309-657-9919
Mailing Address - Fax:
Practice Address - Street 1:1200 TRAIL VIEW PL
Practice Address - Street 2:
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444-6663
Practice Address - Country:US
Practice Address - Phone:309-657-9919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG142753207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine