Basic Information
| Provider Information | |||||||||
| NPI: | 1275516304 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANTHONY | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 265 POSADA LN | ||||||||
| Address2: | SUITE B | ||||||||
| City: | TEMPLETON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934654056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054340900 | ||||||||
| FaxNumber: | 8054349260 | ||||||||
| Practice Location | |||||||||
| Address1: | 265 POSADA LN | ||||||||
| Address2: | SUITE B | ||||||||
| City: | TEMPLETON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934654056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054340900 | ||||||||
| FaxNumber: | 8054349260 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 09/16/2011 | ||||||||
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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 | 207Q00000X | A44962 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | A44962 | CA | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 2396051 | 01 | CA | BLUE CROSS OF CA | OTHER | 00A449620 | 05 | CA | MEDICAID | 10940559 | 01 | CA | CAQH | OTHER |