Provider Demographics
NPI:1992891808
Name:ANDERSON, DAVID BOONE (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BOONE
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 1:12462 PUTNAM ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1048
Mailing Address - Country:US
Mailing Address - Phone:562-789-5449
Mailing Address - Fax:562-789-4449
Practice Address - Street 1:12462 PUTNAM ST
Practice Address - Street 2:SUITE 500
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1048
Practice Address - Country:US
Practice Address - Phone:562-789-5449
Practice Address - Fax:562-789-4449
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56515174400000X
NMMD2014-0254208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G565151Medicaid
CA00G565151Medicaid
CAE33319Medicare UPIN
CA00G565151Medicaid