Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 874 | AK |
Y | 213EG0000X | General Practice | 874 | AK |
NPI | 1003813734 |
---|---|
Provider Name | Dr. Lonnie Arthur Anderson |
First Address | Juneau, AK 99803-2498 |
Second Address | Juneau, AK 99801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 01/12/2015 |