MEDICARE: CONNOR JAMES ANDERSON PA-C

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	363A00000X	Physician Assistant	50.006120RX	OH

General Provider Information

NPI Number	:	1033753926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNOR JAMES ANDERSON PA-C

Provider Business Mailing Address
First Line	:	428 COUNTRY WALK
Second Line	:
City	:	AMHERST
State	:	OH
Zip	:	44001-2635
Country	:	US
Telephone Number	:	440-308-5589
Fax Number	:

Provider Business Practice Location Address
First Line	:	3004 HAYES AVE
Second Line	:
City	:	SANDUSKY
State	:	OH
Zip	:	44870-5321
Country	:	US
Telephone Number	:	419-626-6161
Fax Number	:

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

Provider Enumeration Date	:	11/04/2019
Last Update Date	:	06/14/2022

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Directions to “ CONNOR JAMES ANDERSON PA-C” Practice Location

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