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General NPI Number Information
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NPI Number | 1154373454
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Entity Type | Individual
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Provider Name | GARY D ANDERSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 12/14/2011
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Provider Practice Location Address
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Address Line | 3524 TORRANCE BLVD STE 102
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City | TORRANCE
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State | CA
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Zip | 90503-4821
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Country | US
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Telephone | 310-540-1334
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Fax | 310-540-7615
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Provider Business Mailing Address
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Address Line | 3524 TORRANCE BLVD STE 102
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City | TORRANCE
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State | CA
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Zip | 90503-4821
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Country | US
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Telephone | 310-540-1334
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Fax | 310-540-7615
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | G52512
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License Number State | CA
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