MEDICARE: SEAN F ANDERSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	A94875	CA
2	207L00000X	Anesthesiology Physician	A94875	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A94875	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1144287061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN F ANDERSON MD

Provider Business Mailing Address
First Line	:	PO BOX 34120
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89533-4120
Country	:	US
Telephone Number	:	775-747-5050
Fax Number	:	775-747-5050

Provider Business Practice Location Address
First Line	:	768 MOUNTAIN RANCH RD
Second Line	:
City	:	SAN ANDREAS
State	:	CA
Zip	:	95249-9707
Country	:	US
Telephone Number	:	209-754-4334
Fax Number	:	209-754-3026

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	09/03/2019

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Directions to “ SEAN F ANDERSON MD” Practice Location

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