Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 25560 | MN |
NPI | 1275657348 |
---|---|
Provider Name | Dr. James Lee Anderson |
First Address | Duluth, MN 55804-1732 |
Second Address | Duluth, MN 55804-1732 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D80247 | (02) | MN |