JACK MARTIN ANDERSON (NPI# 1609948223) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609948223 |
| Entity Type | Individual |
| Full Name | JACK MARTIN ANDERSON |
| Credential | M.D. |
| Practice Address |
3003 Health Center Dr San Diego CA 92123-2700 |
| Mailing Address |
8555 Aero Drive, Suite 104 San Diego CA 92123 |
| Practice Telephone | 8589394185 |
| Mailing Telephone | 8583847828 |
| Mailing Fax Number | 8585986344 |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2013-12-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | G60266 | CA | Allopathic & Osteopathic Physicians |
| Y | 2080N0001X |
Pediatrics Specialization: Neonatal-Perinatal Medicine |
G60266 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00G602660 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982254603 | Jack Anderson | Technician | 14810 La Mesa Rd, Victorville, CA 92392-8639 | 2019-09-14 |
| 1154523470 | Jack Anderson | Chiropractor | 226 E 29th St Unit B, Loveland, CO 80538-2825 | 2007-05-31 |
| 1659338887 | Jack Anderson | Emergency Medicine | 9787 N 91st St Ste 101, Scottsdale, AZ 85258-5088 | 2006-05-01 |
| 1881166775 | Jack Raymond Anderson | Surgery | 1730 W 25th St, Cleveland, OH 44113-3108 | 2018-12-18 |
| 1245527969 | Jack D Anderson | Family Medicine | 1515 Edmonton Rd, Tompkinsville, KY 42167-9402 | 2011-07-01 |
| 1134330947 | Jack Glenn Anderson | Psychologist | 200 E Del Mar Blvd, Suite 122, Pasadena, CA 91105-2544 | 2007-05-24 |
| 1417976234 | Jack D Anderson | Pediatrics | 7030 Pineville Matthews Rd, Charlotte, NC 28226-8298 | 2006-07-19 |
| 1992737522 | Jack Anderson | Internal Medicine | 2500 E Capitol Dr, Appleton, WI 54911-8735 | 2006-07-06 |
| 1811964000 | Jack W. Anderson | Anesthesiology | 470 Taylor Rd, Montgomery, AL 36117-3563 | 2006-03-07 |
| Street Address |
3003 HEALTH CENTER DR |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92123-2700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629040605 | Allan T Bombard | Medical Genetics | 3003 Health Center Dr, San Diego, CA 92123 | 2006-02-03 |
| 1053922997 | Amy Crowley | Registered Nurse | 3003 Health Center Dr, San Diego, CA 92123-2700 | 2020-08-13 |
| 1851902266 | Danielle Rae Lourey | Registered Nurse | 3003 Health Center Dr, San Diego, CA 92123-2700 | 2020-08-11 |
| 1073154548 | Lindsay Marie Bonner | Registered Nurse | 3003 Health Center Dr, San Diego, CA 92123-2700 | 2019-10-04 |
| 1952765257 | Karen Anderson | Social Worker | 3003 Health Center Dr, San Diego, CA 92123-2700 | 2016-04-12 |
| 1952799298 | Kim Hui Md | Obstetrics & Gynecology | 3003 Health Center Dr, San Diego, CA 92123-2700 | 2015-01-08 |
| 1669806576 | David Ledezma | Student in an Organized Health Care Education/Training Program | 3003 Health Center Dr, Third Floor-or, San Diego, CA 92123-2700 | 2013-08-27 |
| 1508129818 | Katherine Coughlin | Pediatrics | 3003 Health Center Dr, San Diego, CA 92123-2700 | 2012-06-21 |
| 1982995635 | Brent R. Livingston, M.d., Inc. | Obstetrics & Gynecology | 3003 Health Center Dr, San Diego, CA 92123-2700 | 2011-04-28 |
| 1356585954 | San Diego Neonatology, Inc. | Pediatrics | 3003 Health Center Dr, San Diego, CA 92123-2700 | 2009-04-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669087326 | Corina Lozano Manzo | Registered Nurse | 7436 Mission Center Road, San Diego, CA 92123 | 2020-09-10 |
| 1831703537 | Shannon Leigh Doolittle | Audiologist | 3020 Children's Way Mc5010, San Diego, CA 92123 | 2020-09-01 |
| 1861014359 | Ha Thanh Truong | Pharmacist | Rezcare, 3821 Calle Fortunada, San Diego, CA 92123 | 2020-05-07 |
| 1023667136 | Brittany Meyer | Physical Therapist | 3020 Children's Waymc5068, San Diego, CA 92123 | 2019-09-11 |
| 1598313272 | Ryan Edward Shaw | Marriage & Family Therapist | 8910 Clairmont Mesa Blvd, San Diego, CA 92123 | 2019-08-27 |
| 1528611910 | Tanisha C Fulcher | Marriage & Family Therapist | 8825 Aero Dr., Ste 315, San Diago, CA 92123 | 2019-07-24 |
| 1245795665 | Robin James Pekin | Marriage & Family Therapist | 4450 Kearny Villa Rd, #116, San Diego, CA 92123 | 2019-02-11 |
| 1174093728 | Karen Vences | Counselor | 8755 Aero Dr Suite 230, San Diego, CA 92123 | 2018-11-27 |
| 1255808465 | Natasha Herrera | Counselor | 2801 Meadow Lark Dr, San Diego, San Diego, CA 92123 | 2018-10-25 |
| 1407321987 | Maneka Elikewela | Behavior Technician | 3934 Murphy Canyon Rd, Ste B202, San Diego, CA 92123 | 2018-10-10 |
| Find all providers in zip 92123 | ||||
| Taxonomy Code | 2080N0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Neonatal-Perinatal Medicine |
| A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427502186 | George Francis Tidmarsh | Pediatrics | 10182 Telesis Ct, San Diego, CA 92121-4760 | 2016-08-11 |
| 1518116474 | Aleksandra Janina Zabrocki | Pediatrics | 3262 Lahitte Ct, San Diego, CA 92122-2348 | 2008-09-16 |
| 1639201932 | Amber Pope | Pediatrics | 402 Dickinson St # 8774, Suite Mpf 1-140, San Diego, CA 92103-6902 | 2007-03-12 |
| 1528031457 | Eileen Marie Hoke | Pediatrics | Nmcsd Nicu, 34800 Bob Wilson Drive, San Diego, CA 92134-0001 | 2006-02-10 |
| 1366785644 | Nikolai Shalygin | Pediatrics | 3020 Childrens Way, San Diego, CA 92123-4223 | 2013-04-04 |
| 1356585954 | San Diego Neonatology, Inc. | Pediatrics | 3003 Health Center Dr, San Diego, CA 92123-2700 | 2009-04-27 |
| 1326297730 | Shandee Miquelle Hutson | Pediatrics | 3003 Health Center Drive, San Diego, CA 92354-2804 | 2008-09-10 |
| 1407024995 | Sandra Lawrynowicz Leibel | Pediatrics | 3020 Childrens Way, San Diego, CA 92123-4223 | 2008-02-18 |
| 1427255868 | Kathryn Ann Johnson | Pediatrics | 200 W Arbor Dr, San Diego, CA 92103-9000 | 2007-06-29 |
| 1942405469 | Farhad B. Imam | Pediatrics | 3020 Childrens Way, Mc5008, San Diego, CA 92123-4223 | 2007-06-15 |
| Find all providers in SAN DIEGO | ||||
Please comment or provide details below to improve the information on JACK MARTIN ANDERSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.