Provider Demographics
NPI:1386646347
Name:ANDERSON, CHARLES EDWARD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDWARD
Last Name:ANDERSON
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1180 N INDIAN CANYON DR
Mailing Address - Street 2:STE E408
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4868
Mailing Address - Country:US
Mailing Address - Phone:760-969-5200
Mailing Address - Fax:760-969-5201
Practice Address - Street 1:1180 N INDIAN CANYON DR
Practice Address - Street 2:STE E408
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4800
Practice Address - Country:US
Practice Address - Phone:760-969-5200
Practice Address - Fax:760-969-5201
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
CAG44919207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAA1076911OtherDEA
CAA49813Medicare UPIN