Provider Demographics
NPI:1104040674
Name:EDWARD R. ALEXSON, M.D.,INC
Entity type:Organization
Organization Name:EDWARD R. ALEXSON, M.D.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ALEXSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-835-4800
Mailing Address - Street 1:1401 N TUSTIN AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8689
Mailing Address - Country:US
Mailing Address - Phone:714-835-4800
Mailing Address - Fax:714-835-1900
Practice Address - Street 1:1401 N TUSTIN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8689
Practice Address - Country:US
Practice Address - Phone:714-835-4800
Practice Address - Fax:714-835-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27314207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G273140Medicaid
CA00G273140Medicaid
CA00G273140Medicaid