Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | R8G43 | MO |
NPI | 1154302677 |
---|---|
Provider Name | Scott A Anderson |
First Address | Jefferson City, MO 65109-2444 |
Second Address | Jefferson City, MO 65109-2444 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 23/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1154302677 | (05) | IA |
243615317 | (05) | MO |
E23586 | (02) | MO |