Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 2009023875 | MO |
N | 208600000X | Surgeon | 2009023875 | MO |
Y | 2086S0120X | Pediatric Surgery | ME101934 | FL |
NPI | 1316079411 |
---|---|
Provider Name | Dr. Christopher Michael Anderson |
First Address | Orlando, FL 32804-4603 |
Second Address | Orlando, FL 32804-4603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 26/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1316079411 | (05) | MO |
179100001 | (05) | AR |
431560263 | TRICARE WEST (01) |