Philippe Edouard, M.D., Inc.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

C51257 Issued in CA

Legal business name

PHILIPPE EDOUARD, M.D., INC.

Practice address

1165 Montgomery Dr
Santa Rosa, CA 95405-4801

Phone

(707) 546-3210

NPI assigned

May 25, 2006

Last updated

Mar 24, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Philippe Robert Edouard, M.D.

Title

Owner

Phone

(707) 322-5679

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206316800000",
    "number": "1154377109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 4TH ST",
            "address_2": "#371",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954044057",
            "telephone_number": "707-322-5679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1165 MONTGOMERY DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054801",
            "telephone_number": "707-546-3210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILIPPE EDOUARD, M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2008-03-24",
        "status": "A",
        "authorized_official_last_name": "EDOUARD",
        "authorized_official_first_name": "PHILIPPE",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "707-322-5679",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "C51257",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00C512570",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Kim Phan
• Tuan Quoc Phan, LVN
• Valerie Phan
• Makha Phetphommasouk
• Souliyo Phetsomphou
• Deirdre Phillips
• Dustin Phillips
• Elizabeth Phillips, MD
• Justin D. Phillips, DDS
• Karen Phillips

• Internal Medicine Physician in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.