Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1972790087 |
---|---|
Provider Name | Jeff L Anderson |
First Address | Modesto, CA 95355-4240 |
Second Address | Modesto, CA 95355-4240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2007 |
Last Update Date | 02/10/2007 |