Individual
DR. JOHN DIETRICH ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2104 N VILLAGE DR STE L, TRUCKEE, CA 96161-4312
(530) 582-6594
Mailing address
10865 WHITEHORSE RD, TRUCKEE, CA 96161-1428
(303) 720-9681
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A143587
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
023864
KAISER COMMERCIAL NUMBER
CO
05
—
22556346
—
CO
Enumeration date
04/26/2010
Last updated
03/23/2019
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