Provider Demographics
NPI:1629497581
Name:JOHN P. ANDERSON MD, RUSSELL M. PERRY MD, AND MARK A. SHARZER, AMC
Entity Type:Organization
Organization Name:JOHN P. ANDERSON MD, RUSSELL M. PERRY MD, AND MARK A. SHARZER, AMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTORIZED SIGNER
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:714-670-7400
Mailing Address - Street 1:PO BOX 26570
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-6570
Mailing Address - Country:US
Mailing Address - Phone:559-455-4065
Mailing Address - Fax:770-666-9103
Practice Address - Street 1:931 S COCHRAN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4738
Practice Address - Country:US
Practice Address - Phone:310-251-1333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHW4831Medicare PIN