Provider Demographics
NPI:1528028156
Name:ANDERSON, DANIEL D (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:D
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:785 HANA WAY
Practice Address - Street 2:STE 102
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3885
Practice Address - Country:US
Practice Address - Phone:916-983-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57674207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF52226Medicare UPIN
CA00G576740Medicare PIN