Healthcare Provider Details

I. General information

NPI: 1053441436
Provider Name (Legal Business Name): SCOTT DODD ANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9261 FOLSOM BLVD STE 200
SACRAMENTO CA
95826-2559
US

IV. Provider business mailing address

1442 EL NIDO WAY
SACRAMENTO CA
95864-2904
US

V. Phone/Fax

Practice location:
  • Phone: 916-364-1733
  • Fax: 916-364-5255
Mailing address:
  • Phone: 916-484-0347
  • Fax: 916-484-0347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberG33616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: