Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | G25242 | CA |
NPI | 1063590131 |
---|---|
Provider Name | Gregory D. Anderson |
First Address | Oakland, CA 94612-3429 |
Second Address | Walnut Creek, CA 94596-5318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G252420 | (05) | CA |
A42585 | (02) |