Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN11025 | FL |
NPI | 1033213343 |
---|---|
Provider Name | Dr. Thomas Allen Anderson |
First Address | Bradenton, FL 34209 |
Second Address | Bradenton, FL 34209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U01845 | (02) |