Provider Demographics
NPI:1376286872
Name:ANDERSON, ERIK ALLEN (DO)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:ALLEN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 E 31STSTREET
Mailing Address - Street 2:QIC 22134
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602
Mailing Address - Country:US
Mailing Address - Phone:510-437-4743
Mailing Address - Fax:510-437-5017
Practice Address - Street 1:1411 E 31STSTREET
Practice Address - Street 2:QIC 22134
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602
Practice Address - Country:US
Practice Address - Phone:510-437-4743
Practice Address - Fax:510-437-5017
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program