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General NPI Number Information
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NPI Number | 1861552689
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Entity Type | Organization
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Legal Business Name | JEFFERY ANDERSON M.D.
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 291 WATER VIEW WAY
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City | FOLSOM
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State | CA
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Zip | 95630-5041
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Country | US
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Telephone | 916-983-1625
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 34120
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City | RENO
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State | NV
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Zip | 89533-4120
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Country | US
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Telephone | 775-747-5050
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Fax | 775-747-5005
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Authorized Official
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Title or Position | CEO
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Name | JEFFREY ANDERSON
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Credential | M.D.
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Telephone | 916-983-1625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | G58154
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License Number State | CA
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