Provider Demographics
NPI:1154363141
Name:ALEXSON, EDWARD ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ROBERT
Last Name:ALEXSON
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 1:1401 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 220
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
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27314207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G273140Medicaid
CA00G273140Medicaid
CAG27314Medicare ID - Type Unspecified