Individual
MR. JOHN M EDISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3003 LOMA VISTA RD, STE. A, VENTURA, CA 93003-2935
(805) 648-3081
(805) 648-2659
Mailing address
3003 LOMA VISTA RD, STE. A, VENTURA, CA 93003-2935
(805) 648-3081
(805) 648-2659
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
C27589
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C275890
BLUE SHIELD OF CALIFORNIA
—
05
—
00C275890
—
CA
01
—
C27589
ALL OTHER INSURANCES
—
Enumeration date
09/29/2005
Last updated
07/08/2007
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