Provider Demographics
NPI:1114032620
Name:ANDERS, ALPHA JEROME (MD)
Entity type:Individual
Prefix:
First Name:ALPHA
Middle Name:JEROME
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:PO BOX 2809
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93303-2809
Mailing Address - Country:US
Mailing Address - Phone:661-633-5474
Mailing Address - Fax:661-633-9276
Practice Address - Street 1:2828 H ST STE D
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1900
Practice Address - Country:US
Practice Address - Phone:661-633-5474
Practice Address - Fax:661-633-9276
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52224207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G522240Medicaid
CAA52205Medicare UPIN
CA00G522240Medicaid