Healthcare Provider Details

I. General information

NPI: 1649229105
Provider Name (Legal Business Name): JAMES MCCALL ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 01/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3309 RENNER DR
FORTUNA CA
95540-3119
US

IV. Provider business mailing address

3309 RENNER DR
FORTUNA CA
95540-3119
US

V. Phone/Fax

Practice location:
  • Phone: 707-725-0618
  • Fax: 707-725-9674
Mailing address:
  • Phone: 707-725-0618
  • Fax: 707-725-9674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA25979
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: