Individual
JIM DOUGLAS ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
23 GRANITE CT, SAN CARLOS, CA 94070-4306
(415) 298-6656
(650) 366-9401
Mailing address
23 GRANITE CT, SAN CARLOS, CA 94070-4306
(415) 298-6656
(650) 366-9401
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
G29493
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G29493
CA MEDICAL LICENCE
—
Enumeration date
03/11/2016
Last updated
03/11/2016
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