Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | C32041 | CA |
NPI | 1013082429 |
---|---|
Provider Name | John Anderson |
First Address | Atherton, CA 94027-3103 |
Second Address | San Mateo, CA 94403-4364 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 23/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00C320410 | (05) | CA |
A34795 | (02) | CA |