Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 16163 | MS |
NPI | 1003831397 |
---|---|
Provider Name | Dr. Shawn C Anderson |
First Address | Meridian, MS 39301-4130 |
Second Address | Meridian, MS 39301-4130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 09/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00120272 | (05) | MS |