Provider Demographics
NPI:1194990747
Name:ANDERSON, FREDERICK RYAN (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:RYAN
Last Name:ANDERSON
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 1:909 SAN RAMON VALLEY BLVD STE #214
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-4038
Mailing Address - Country:US
Mailing Address - Phone:925-820-9898
Mailing Address - Fax:925-820-6514
Practice Address - Street 1:909 SAN RAMON VALLEY BLVD STE #214
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4038
Practice Address - Country:US
Practice Address - Phone:925-820-9898
Practice Address - Fax:925-820-6514
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG021295207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology