Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 284 | NM |
Y | 222Z00000X | Podiatrist | 284 | NM |
N | 213EP1101X | Primary Podiatric Medicine | 284 | NM |
N | 111NR0200X | Radiology | 284 | NM |
N | 213ER0200X | Radiology | 284 | NM |
N | 2081S0010X | Sports Medicine | 284 | NM |
N | 213ES0000X | Sports Medicine | 284 | NM |
N | 213ES0103X | Foot & Ankle Surgery | 284 | NM |
N | 213ES0131X | Foot Surgery | 284 | NM |
NPI | 1235101940 |
---|---|
Provider Name | Dr. John J Anderson |
First Address | Alamogordo, NM 88310-4607 |
Second Address | Alamogordo, NM 88310-4607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2006 |
Last Update Date | 17/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000L1222 | (05) | NM |
201038108 | PRESBYTERIAN HEALTH PLAN (01) | NM |
NM005A02 | BLUE CROSS BLUE SHIELD ID (01) | NM |
U90748 | (02) | NM |