1659782100 NPI number — JAMIE ELIZABETH ANDERSON M.D.

Table of content: JAMIE ELIZABETH ANDERSON M.D. (NPI 1659782100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659782100 NPI number — JAMIE ELIZABETH ANDERSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
JAMIE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659782100
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UC DAVIS DEPARTMENT OF SURGERY
Provider Second Line Business Mailing Address:
2335 STOCKTON BLVD., 5TH FLOOR
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95817-2201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-703-4473
Provider Business Mailing Address Fax Number:
916-734-5633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2315 STOCKTON BLVD
Provider Second Line Business Practice Location Address:
SUITE OP 512 PAVILION
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95817-2201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-734-2724
Provider Business Practice Location Address Fax Number:
916-734-5633
Provider Enumeration Date:
05/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0120X , with the licence number:  A140553 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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