Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 15032 | NV |
Y | 208800000X | Urologist | C127871 | CA |
NPI | 1053403105 |
---|---|
Provider Name | Dr. Bradley W Anderson |
First Address | South Lake Tahoe, CA 96150-6207 |
Second Address | South Lake Tahoe, CA 96150-7059 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 16/07/2014 |