Organization
RUSSELL P EDWARDS, MD APC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL P EDWARDS M.D. (OWNER)
(619) 291-6191
Entity
Organization
Contact information
Practice address
3969 4TH AVE, SUITE 301, SAN DIEGO, CA 92103-3165
(619) 291-6191
(619) 291-0049
Mailing address
3969 4TH AVE, SUITE 301, SAN DIEGO, CA 92103-3165
(619) 291-6191
(619) 291-0049
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
G57008
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G570080
—
CA
01
—
WG57008B
MEDICARE GROUP PIN
CA
Enumeration date
02/06/2007
Last updated
02/06/2015
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