Provider Demographics
NPI:1932231495
Name:ANDERSON, GINA KATHLEEN (DO)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:KATHLEEN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3228 NW CREST DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-1807
Mailing Address - Country:US
Mailing Address - Phone:541-760-9644
Mailing Address - Fax:
Practice Address - Street 1:650 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4437
Practice Address - Country:US
Practice Address - Phone:541-207-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A104862084N0400X
TXP11572084N0400X
ORDO1594572084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology