Anderson, Jack Martin

Anderson, Jack Martin is an individual health care provider with primary practice located at 3003 Health Center Dr , San Diego CA 92123-2700. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine. Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine is his primary health care specialty. Anderson, Jack Martin can be contacted via phone (858) 939-4185.

Contact Information

Primary practice address
3003 Health Center Dr San Diego CA 92123-2700
Phone: (858) 939-4185
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X G60266 California
Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine 2080N0001X G60266 California

Profile Details

NPI number 1609948223
LBN Legal business name Anderson, Jack Martin
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 15th, 2006
Last updated Dec 11th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609948223 NPPES
California MEDICAID 00G602660

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