Individual
JACK MARTIN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3003 HEALTH CENTER DR, SAN DIEGO, CA 92123-2700
(858) 939-4185
Mailing address
8555 AERO DRIVE, SUITE 104, SAN DIEGO, CA 92123
(858) 384-7828
(858) 598-6344
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
G60266
CA
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
G60266
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G602660
—
CA
Enumeration date
11/15/2006
Last updated
12/11/2013
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