Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | MD0000019697 | TN |
NPI | 1003993163 |
---|---|
Provider Name | Dr. Mark D Anderson |
First Address | Knoxville, TN 37995-0001 |
Second Address | Knoxville, TN 37920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 27/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2005657 | BCBS OF TN (01) | TN |
E07090 | (02) |