Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 125050891 | IL |
Y | 207VX0201X | Gynecologic Oncologist | MD161964 | OR |
NPI | 1215191259 |
---|---|
Provider Name | Dr. Charles Kellogg Anderson |
First Address | Eugene, OR 97401-6036 |
Second Address | Eugene, OR 97401-6036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2008 |
Last Update Date | 05/08/2021 |