Provider Demographics
NPI:1932173713
Name:EDWARDS, TINA FORTHUN (MD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:FORTHUN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:FORTHUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:NMCSD, EMERGENCY DEPARTMENT
Mailing Address - Street 2:34800 BOB WILSON DRIVE
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-1014
Mailing Address - Country:US
Mailing Address - Phone:619-532-8274
Mailing Address - Fax:
Practice Address - Street 1:NMCSD, EMERGENCY DEPARTMENT
Practice Address - Street 2:34800 BOB WILSON DRIVE
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-1014
Practice Address - Country:US
Practice Address - Phone:619-532-8274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93271207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine