Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD18613 | TN |
Y | 111NI0900X | Internist | MD18613 | TN |
NPI | 1003801788 |
---|---|
Provider Name | Mr. John E Anderson |
First Address | Nashville, TN 37203-1562 |
Second Address | Nashville, TN 37203-1562 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2005 |
Last Update Date | 17/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3043893 | (05) | TN |
64918618 | (05) | KY |
D93201 | (02) | TN |