Provider Demographics
NPI:1063619245
Name:TODD ANDERSON MD INC.
Entity type:Organization
Organization Name:TODD ANDERSON MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-653-7600
Mailing Address - Street 1:100 N BRENT ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2822
Mailing Address - Country:US
Mailing Address - Phone:805-653-7600
Mailing Address - Fax:805-653-7605
Practice Address - Street 1:100 N BRENT ST
Practice Address - Street 2:SUITE 203
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2822
Practice Address - Country:US
Practice Address - Phone:805-653-7600
Practice Address - Fax:805-653-7605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTIN
CAE47953Medicare UPIN