Provider Demographics
NPI:1629005483
Name:ANDERSON, DAVID H (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:H
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 1:1312 PRENTICE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3381
Mailing Address - Country:US
Mailing Address - Phone:707-433-3383
Mailing Address - Fax:707-433-7210
Practice Address - Street 1:1312 PRENTICE DRIVE
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3381
Practice Address - Country:US
Practice Address - Phone:707-433-3383
Practice Address - Fax:707-433-7210
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC30531207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00C305310OtherMEDI CAL
00C305310OtherMEDI CAL
CA00C305310Medicare ID - Type Unspecified