Provider Demographics
NPI:1124369087
Name:ANDERS, DOUGLAS STEPHAN (DO)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:STEPHAN
Last Name:ANDERS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:81 HIGHLAND SPRINGS AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-3170
Mailing Address - Country:US
Mailing Address - Phone:951-769-2222
Mailing Address - Fax:951-769-2204
Practice Address - Street 1:81 HIGHLAND SPRINGS AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-3170
Practice Address - Country:US
Practice Address - Phone:951-769-2222
Practice Address - Fax:951-769-2204
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA2OA6395207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG16442Medicare UPIN