Provider Demographics
NPI:1447344270
Name:EDES, ELLIOTT (MD)
Entity type:Individual
Prefix:MR
First Name:ELLIOTT
Middle Name:
Last Name:EDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 265 RAMON RD
Mailing Address - Street 2:B-1
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234
Mailing Address - Country:US
Mailing Address - Phone:760-770-5880
Mailing Address - Fax:760-770-5875
Practice Address - Street 1:69 265 RAMON RD
Practice Address - Street 2:B-1
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234
Practice Address - Country:US
Practice Address - Phone:760-770-5880
Practice Address - Fax:760-770-5875
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59464207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology