Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 208600000X | DC |
N | 208600000X | Surgeon | 208600000X | DC |
Y | 208200000X | Surgeon | A171538 | CA |
Y | 208600000X | Surgeon | A171538 | CA |
N | 2086X0206X | Surgical Oncologist | A171538 | CA |
NPI | 1013335082 |
---|---|
Provider Name | Dr. Brandon Jamal Anderson |
First Address | Los Angeles, CA 90051-0185 |
Second Address | Duarte, CA 91010-3012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2014 |
Last Update Date | 06/05/2021 |