Theodore Durner Edson, M.D.

Primary specialty

Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X

License

036120197 Issued in IL

Practice address

Naval Medical Center San Diego 34800 Bob Wilson Drive
San Diego, CA 92134-5191

Phone

(619) 532-7575

NPI assigned

Jul 21, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1121904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1679572572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3456 MOON FIELD DR",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920085542",
            "telephone_number": "760-729-2018",
            "fax_number": "760-725-0117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "NAVAL MEDICAL CENTER SAN DIEGO 34800 BOB WILSON DRIVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921345191",
            "telephone_number": "619-532-7575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDSON",
        "first_name": "THEODORE",
        "middle_name": "DURNER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-21",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "IL",
            "license": "036120197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wryonna Edquiban, CMPSS
• Alayna Edquid
• Rosario Cecilia Perez Edquid
• Emilio Chan Edquilang Jr.
• Marcy Anna Edson, M.S. SLP
• Rachelle Marie Keltner Edstrom, O.D.
• Eduardo Diaz DDS PC
• Pia Alissa Edusada
• Edward Ayub M S a P C
• Edward C Federman M D Inc

• Colon & Rectal Surgery Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Colon & Rectal Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.