Provider Demographics
NPI:1588763148
Name:ANDERSON, CRAIG FRASER (DPM)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:FRASER
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 BERKELEY AVE
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-2308
Mailing Address - Country:US
Mailing Address - Phone:650-322-4533
Mailing Address - Fax:
Practice Address - Street 1:681 OAK GROVE AVE STE F
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4333
Practice Address - Country:US
Practice Address - Phone:650-325-0322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3797213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist