Provider Demographics
NPI:1801086814
Name:JOSEPH C. ANDERSON M.D., INC.
Entity type:Organization
Organization Name:JOSEPH C. ANDERSON M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:CALVIN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-542-9111
Mailing Address - Street 1:21825 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-7003
Mailing Address - Country:US
Mailing Address - Phone:310-542-9111
Mailing Address - Fax:310-214-5263
Practice Address - Street 1:21825 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-7003
Practice Address - Country:US
Practice Address - Phone:310-542-9111
Practice Address - Fax:310-214-5263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25031207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG25031AMedicaid
CA0665150001Medicare NSC
CAW14561Medicare PIN
CAWG25031AMedicaid