Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0208X | Pediatric Infectious Diseases | 19571 | NC |
Y | 2080P0208X | Pediatric Infectious Diseases | R5J69 | MO |
NPI | 1295885580 |
---|---|
Provider Name | Dr. Edwin Lemuel Anderson |
First Address | Saint Louis, MO 63104-1015 |
Second Address | Saint Louis, MO 63104-1015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 24/05/2013 |