| Philippe Edouard, M.d., Inc. | |
|
1165 Montgomery Dr Santa Rosa CA 95405-4801 | |
| (707) 546-3210 | |
| Not Available |
| Full Name | Philippe Edouard, M.d., Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 1165 Montgomery Dr, Santa Rosa, California |
| Authorized Official Name and Position | Philippe Robert Edouard (OWNER) |
| Authorized Official Contact | 7073225679 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Philippe Edouard, M.d., Inc. 1275 4th St #371 Santa Rosa CA 95404-4057 Ph: (707) 322-5679 | Philippe Edouard, M.d., Inc. 1165 Montgomery Dr Santa Rosa CA 95405-4801 Ph: (707) 546-3210 |
| NPI Number | 1154377109 |
|---|---|
| Provider Enumeration Date | 05/25/2006 |
| Last Update Date | 03/24/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154377109 | NPI | - | NPPES |
| 00C512570 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | C51257 (California) | Primary |
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