Healthcare Provider Details

I. General information

NPI: 1770684946
Provider Name (Legal Business Name): EDWARD G STOKES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 NORTH CENTRAL AVENUE 207
GLENDALE CA
91203-1403
US

IV. Provider business mailing address

980 ATLANTIC AVENUE 3RD FLOOR
LONG BEACH CA
90813-4570
US

V. Phone/Fax

Practice location:
  • Phone: 818-244-6792
  • Fax: 818-244-7477
Mailing address:
  • Phone: 562-624-0776
  • Fax: 562-624-0786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG25145
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: