Healthcare Provider Details

I. General information

NPI: 1154373454
Provider Name (Legal Business Name): GARY D ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3524 TORRANCE BLVD STE 102
TORRANCE CA
90503-4821
US

IV. Provider business mailing address

3524 TORRANCE BLVD STE 102
TORRANCE CA
90503-4821
US

V. Phone/Fax

Practice location:
  • Phone: 310-540-1334
  • Fax: 310-540-7615
Mailing address:
  • Phone: 310-540-1334
  • Fax: 310-540-7615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG52512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: