Provider Demographics
NPI:1407842339
Name:ADULT MEDICINE SPECIALISTS, INC
Entity Type:Organization
Organization Name:ADULT MEDICINE SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-533-0333
Mailing Address - Street 1:690 GUZZI LN
Mailing Address - Street 2:STE C
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5289
Mailing Address - Country:US
Mailing Address - Phone:209-533-0333
Mailing Address - Fax:209-533-0782
Practice Address - Street 1:690 GUZZI LN
Practice Address - Street 2:STE C
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5289
Practice Address - Country:US
Practice Address - Phone:209-533-0333
Practice Address - Fax:209-533-0782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG033960207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ35562ZOtherGRP #
P00002757OtherRAILROAD MEDICARE
CAA53084Medicare UPIN
CAH12760Medicare UPIN
CAZZZ35562ZOtherGRP #