Healthcare Provider Details

I. General information

NPI: 1104040674
Provider Name (Legal Business Name): EDWARD R. ALEXSON, M.D.,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N TUSTIN AVE SUITE A
SANTA ANA CA
92705-8689
US

IV. Provider business mailing address

1401 N TUSTIN AVE SUITE 220
SANTA ANA CA
92705-8689
US

V. Phone/Fax

Practice location:
  • Phone: 714-835-4800
  • Fax: 714-835-1900
Mailing address:
  • Phone: 714-835-4800
  • Fax: 714-835-1900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberG27314
License Number StateCA

VIII. Authorized Official

Name: DR. EDWARD ROBERT ALEXSON
Title or Position: DOCTOR
Credential: M.D.
Phone: 714-835-4800