Provider Demographics
NPI:1255355053
Name:ANDERSEN, BARBARA G (MD)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:G
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: MANAGED CARE DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:58295 29 PALMS HWY
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-5803
Practice Address - Country:US
Practice Address - Phone:760-365-6300
Practice Address - Fax:760-396-1200
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52853174400000X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4138200OtherAETNA
CAGR0063580Medicaid
CAP00759920OtherRAILROAD MEDICARE
CA3753022OtherCIGNA
CA00G528530Medicare PIN
CA4138200OtherAETNA
CAE07543Medicare UPIN
CAGR0063580Medicaid