Provider Demographics
NPI:1346530664
Name:ANDERSON, JAMES GIBSON JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:GIBSON
Last Name:ANDERSON
Suffix:JR
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 1:747 52ND ST
Mailing Address - Street 2:EAST BAY NEWBORN SPECIALISTS, INC
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1809
Mailing Address - Country:US
Mailing Address - Phone:510-428-3282
Mailing Address - Fax:510-450-5823
Practice Address - Street 1:747 52ND ST
Practice Address - Street 2:EAST BAY NEWBORN SPECIALISTS, INC
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1809
Practice Address - Country:US
Practice Address - Phone:510-428-3282
Practice Address - Fax:510-450-5823
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA123380208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program