Provider Demographics
NPI:1871549642
Name:DAG, EDWARD (MD)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:DAG
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:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:1390 E YOSEMITE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8221
Practice Address - Country:US
Practice Address - Phone:209-580-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33266207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A332660Medicaid
A27092Medicare UPIN
CA00A332663Medicare PIN
CA00A332664Medicare PIN