Individual
EDWARD EVERETT HEROLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1555 SOQUEL DR, SANTA CRUZ, CA 95065-1705
(831) 462-7700
Mailing address
PO BOX 49168, SAN JOSE, CA 95161-9168
(503) 372-2740
(503) 372-2754
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G79072
CA
207LP2900X
Pain Medicine (Anesthesiology) Physician
G79072
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G790720
—
CA
Enumeration date
05/11/2006
Last updated
04/07/2011
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