Provider Demographics
NPI:1053441436
Name:ANDERSON, SCOTT DODD (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DODD
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1442 EL NIDO WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-2904
Mailing Address - Country:US
Mailing Address - Phone:916-484-0347
Mailing Address - Fax:916-484-0347
Practice Address - Street 1:9261 FOLSOM BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-2559
Practice Address - Country:US
Practice Address - Phone:916-364-1733
Practice Address - Fax:916-364-5255
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG336162083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA45164Medicare UPIN