Provider Demographics
NPI:1700846755
Name:ANDERSON, MALCOLM FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:MALCOLM
Middle Name:FRANCIS
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: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:559-455-4000
Mailing Address - Fax:
Practice Address - Street 1:1243 E SPRUCE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3379
Practice Address - Country:US
Practice Address - Phone:559-439-7226
Practice Address - Fax:559-256-2983
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA298752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A298750Medicaid
CA00A298750OtherBLUE SHIELD
CA00A298750Medicaid
CAA25899Medicare UPIN
CAP00082778Medicare PIN