Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0207X | Pediatric Hematology-Oncologist | 055084 | GA |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 24783 | SC |
NPI | 1124175146 |
---|---|
Provider Name | Alan Randall Anderson |
First Address | Greenville, SC 29601-2842 |
Second Address | Greenville, SC 29605-4255 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 19/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
247833 | (05) | SC |
576007863054 | BCBS (01) | SC |