Provider Demographics
NPI:1942437348
Name:ANDERSON, JEFFRY L (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFRY
Middle Name:L
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 1:105 MARIN ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-4944
Mailing Address - Country:US
Mailing Address - Phone:415-258-1775
Mailing Address - Fax:415-258-1765
Practice Address - Street 1:105 MARIN ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-4944
Practice Address - Country:US
Practice Address - Phone:415-258-1775
Practice Address - Fax:415-258-1765
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC325722083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine