Basic Information
| Provider Information | |||||||||
| NPI: | 1003002494 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 802 B ST | ||||||||
| Address2: | |||||||||
| City: | SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949013026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4157348726 | ||||||||
| FaxNumber: | 4157624220 | ||||||||
| Practice Location | |||||||||
| Address1: | 802 B ST | ||||||||
| Address2: | |||||||||
| City: | SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949013026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4157348726 | ||||||||
| FaxNumber: | 4157624220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2007 | ||||||||
| LastUpdateDate: | 09/19/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0101X | A98379 | CA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
No ID Information.