Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 20106 | CA |
N | 111NI0013X | Independent Medical Examiner | B-866 | NV |
NPI | 1619175288 |
---|---|
Provider Name | Mr. Russell N Anderson |
First Address | Tehachapi, CA 93561-6438 |
Second Address | Tehachapi, CA 93561-6438 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2007 |
Last Update Date | 07/12/2009 |