Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 14961 | SC |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 14961 | SC |
NPI | 1609988260 |
---|---|
Provider Name | Joseph Thomas Anderson |
First Address | Greenville, SC 29601-2842 |
Second Address | Greenville, SC 29615-6322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 19/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
149618 | (05) | SC |
576007863133 | BLUE CHOICE OF SC (01) | SC |
576007863178 | BCBS (01) | SC |
F78135 | (02) | SC |
P00403514 | RR MEDICARE (01) | SC |