Healthcare Provider Details

I. General information

NPI: 1760487227
Provider Name (Legal Business Name): ROBERT R ANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S ELISEO DR STE 102
GREENBRAE CA
94904-2152
US

IV. Provider business mailing address

900 S ELISEO DR STE 102
GREENBRAE CA
94904-2152
US

V. Phone/Fax

Practice location:
  • Phone: 415-461-8200
  • Fax: 415-461-4627
Mailing address:
  • Phone: 415-461-8200
  • Fax: 415-461-4627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number00G305540
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: