Provider Demographics
NPI:1437767175
Name:ANDERSON ORTHOPAEDIC SURGERY, A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ANDERSON ORTHOPAEDIC SURGERY, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-717-1070
Mailing Address - Street 1:9715 KING RD
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-8013
Mailing Address - Country:US
Mailing Address - Phone:916-717-1070
Mailing Address - Fax:916-652-0876
Practice Address - Street 1:1600 CREEKSIDE DR STE 1300
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3445
Practice Address - Country:US
Practice Address - Phone:916-292-9394
Practice Address - Fax:916-652-0876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty