Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | MD446593 | PA |
NPI | 1174841258 |
---|---|
Provider Name | John Anthony Anderson |
First Address | Philadelphia, PA 19107-4414 |
Second Address | Philadelphia, PA 19107-4216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2010 |
Last Update Date | 10/11/2015 |