Provider Demographics
NPI:1447325873
Name:ANDERS, PAUL DAMON (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAMON
Last Name:ANDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2039 FOREST AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4817
Mailing Address - Country:US
Mailing Address - Phone:408-292-5151
Mailing Address - Fax:
Practice Address - Street 1:2039 FOREST AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4817
Practice Address - Country:US
Practice Address - Phone:408-292-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG2960174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4173Medicare UPIN
00G290600Medicare ID - Type Unspecified