Healthcare Provider Details

I. General information

NPI: 1154363141
Provider Name (Legal Business Name): EDWARD ROBERT ALEXSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N TUSTIN AVE SUITE 220
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:
Title or Position:
Credential:
Phone: