Healthcare Provider Details

I. General information

NPI: 1508837279
Provider Name (Legal Business Name): PHILIP A EDINGTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1899 W MARCH LN
STOCKTON CA
95207-6402
US

IV. Provider business mailing address

1805 N CALIFORNIA ST SUITE 101
STOCKTON CA
95204-6037
US

V. Phone/Fax

Practice location:
  • Phone: 209-623-4700
  • Fax: 209-948-9321
Mailing address:
  • Phone: 209-948-5515
  • Fax: 209-948-9321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG58380
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG58380
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: