Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | DD3103 | NM |
Y | 1223G0001X | General Practice | DD3103 | NM |
Y | 213EG0000X | General Practice | DD3103 | NM |
NPI | 1396919106 |
---|---|
Provider Name | Dr. Stewart Joseph Anderson |
First Address | Albuquerque, NM 87111-2503 |
Second Address | Albuquerque, NM 87111-2503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2008 |
Last Update Date | 30/03/2015 |