MEDICARE: MR. RONALD E. ANDERSON L.AC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	470	CT
2	171100000X	Acupuncturist	AP3541	FL

General Provider Information

NPI Number	:	1023454170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD E. ANDERSON L.AC.

Provider Business Mailing Address
First Line	:	PO BOX 47922
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33743-7922
Country	:	US
Telephone Number	:	727-593-4149
Fax Number	:

Provider Business Practice Location Address
First Line	:	9724 N ARMENIA AVE STE 400
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-7550
Country	:	US
Telephone Number	:	813-464-0967
Fax Number	:	813-933-0968

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2013
Last Update Date	:	03/17/2018

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