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Individual
PAUL ROGER ANDERSON
Active
Individual
PAUL ROGER ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
PA15414
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0PA154140
BLUE SHIELD
CA
05
—
0PA154140
—
CA
Enumeration date
11/07/2005
Last updated
05/09/2008
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