Healthcare Provider Details

I. General information

NPI: 1386006278
Provider Name (Legal Business Name): MARK JOSEPH ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 09/11/2025
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 PARNASSUS AVE # S321
SAN FRANCISCO CA
94143-2205
US

IV. Provider business mailing address

513 PARNASSUS AVE # S321
SAN FRANCISCO CA
94143-2205
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1239
  • Fax:
Mailing address:
  • Phone: 415-476-1239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberA53655088024
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: