Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 19984 | LA |
NPI | 1013094416 |
---|---|
Provider Name | Dr. Robert Michael Anderson |
First Address | Lake Charles, LA 70605-3932 |
Second Address | Lake Charles, LA 70601-8911 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 29/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F85184 | (02) | LA |