Healthcare Provider Details

I. General information

NPI: 1437152378
Provider Name (Legal Business Name): JAMES M ANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

3695 GREEN RD UNIT 22778
BEACHWOOD OH
44122-7939
US

V. Phone/Fax

Practice location:
  • Phone: 216-255-5728
  • Fax: 727-767-3593
Mailing address:
  • Phone: 216-255-5728
  • Fax: 727-767-3593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberME94559
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberC175197
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number56015
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberDR.0067049
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: