Provider Demographics
NPI:1003840596
Name:ANDERSON, EDWARD TEMPLE (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:TEMPLE
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 WAVERLEY ST
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2747
Mailing Address - Country:US
Mailing Address - Phone:650-327-2371
Mailing Address - Fax:
Practice Address - Street 1:1950 UNIVERSITY AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:E PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-2250
Practice Address - Country:US
Practice Address - Phone:650-617-8100
Practice Address - Fax:650-327-2947
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24095207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23816Medicare UPIN