Provider Demographics
NPI:1992794762
Name:ANDERSON, DEBORAH JUNE (MD)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:JUNE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 BUSCHMANN RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-5848
Mailing Address - Country:US
Mailing Address - Phone:530-877-2243
Mailing Address - Fax:530-877-5296
Practice Address - Street 1:771 BUSCHMANN RD
Practice Address - Street 2:SUITE K
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-5848
Practice Address - Country:US
Practice Address - Phone:530-877-2243
Practice Address - Fax:530-877-5296
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42754207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G427540Medicaid
CA00G427540Medicare ID - Type Unspecified