Provider Demographics
NPI:1467567511
Name:JOHN P ANDERSON MD RUSSELL M PERRY MD AND MARK A SHARZER MD A MED CRP
Entity Type:Organization
Organization Name:JOHN P ANDERSON MD RUSSELL M PERRY MD AND MARK A SHARZER MD A MED CRP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHARZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-229-4060
Mailing Address - Street 1:PO BOX 646
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-0646
Mailing Address - Country:US
Mailing Address - Phone:562-809-3513
Mailing Address - Fax:
Practice Address - Street 1:3033 WEST ORANGE AVE.
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804
Practice Address - Country:US
Practice Address - Phone:714-229-4060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0066250Medicaid
CAGR0066250Medicaid