Provider Demographics
NPI:1346233822
Name:ANDERSON, GAIL A (MD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:A
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 1:2080 MAPLE GLEN RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-1638
Mailing Address - Country:US
Mailing Address - Phone:916-485-3636
Mailing Address - Fax:
Practice Address - Street 1:2080 MAPLE GLEN RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-1638
Practice Address - Country:US
Practice Address - Phone:916-485-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35336207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G353360OtherMEDICARE PTAN NUMBER
CAGR0028370Medicaid
CAZZZ16448ZMedicare ID - Type Unspecified