Provider Demographics
NPI:1700083771
Name:ALBERT ANDERSON MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ALBERT ANDERSON MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:760-320-6988
Mailing Address - Street 1:552 S PASEO DOROTEA
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-1437
Mailing Address - Country:US
Mailing Address - Phone:760-320-6988
Mailing Address - Fax:760-320-9796
Practice Address - Street 1:552 S PASEO DOROTEA
Practice Address - Street 2:SUITE 2
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-1437
Practice Address - Country:US
Practice Address - Phone:760-320-6988
Practice Address - Fax:760-320-9796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56013208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05873ZMedicare PIN