Provider Demographics
NPI:1194849570
Name:ANDERSON, JOSEPH CALVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CALVIN
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 1:21825 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-7003
Mailing Address - Country:US
Mailing Address - Phone:310-542-9111
Mailing Address - Fax:310-214-5263
Practice Address - Street 1:21825 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-7003
Practice Address - Country:US
Practice Address - Phone:310-542-9111
Practice Address - Fax:310-214-5263
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25031207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG25031AMedicaid
CAWG025031AMedicare PIN
CAWG25031AMedicaid