Provider Demographics
NPI:1760487227
Name:ANDERSON, ROBERT R (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:900 S ELISEO DR
Mailing Address - Street 2:STE 102
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2152
Mailing Address - Country:US
Mailing Address - Phone:415-461-8200
Mailing Address - Fax:415-461-4627
Practice Address - Street 1:900 S ELISEO DR
Practice Address - Street 2:STE 102
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2152
Practice Address - Country:US
Practice Address - Phone:415-461-8200
Practice Address - Fax:415-461-4627
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2011-10-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA00G305540207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G305540Medicaid
7SG181668OtherRAILROAD MEDICARE
CA00G305540Medicaid
A44463Medicare UPIN