Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | G25031 | CA |
NPI | 1194849570 |
---|---|
Provider Name | Dr. Joseph Calvin Anderson |
First Address | Torrance, CA 90503-7003 |
Second Address | Torrance, CA 90503-7003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 24/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A90911 | (02) | CA |
WG25031A | (05) | CA |