Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 35092 | NC |
NPI | 1043236177 |
---|---|
Provider Name | Dr. Mark Jerome Anderson |
First Address | Hickory, NC 28601-3760 |
Second Address | Hickory, NC 28601-3760 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8911247 | (05) | NC |
E09219 | (02) | NC |