Provider Demographics
NPI:1679572572
Name:EDSON, THEODORE DURNER (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:DURNER
Last Name:EDSON
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 1:3456 MOON FIELD DR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-5542
Mailing Address - Country:US
Mailing Address - Phone:760-729-2018
Mailing Address - Fax:760-725-0117
Practice Address - Street 1:NAVAL MEDICAL CENTER SAN DIEGO 34800 BOB WILSON DRIVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-5191
Practice Address - Country:US
Practice Address - Phone:619-532-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036120197208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery