=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104982842
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALPHA J. ANDERS MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2006
-----------------------------------------------------
Last Update Date | 11/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1409 FENWICK DR
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93312-4647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-633-5474
-----------------------------------------------------
Fax | 661-633-9276
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2809
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93303-2809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-633-5474
-----------------------------------------------------
Fax | 661-633-9276
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ALPHA JEROME ANDERS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 661-633-5474
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------