MEDICARE: DR. JULIE A ANDERSON M.D.

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	207Q00000X	Family Medicine Physician	ME87349	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417942236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE A ANDERSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 10744
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33757-8744
Country	:	US
Telephone Number	:	727-532-0002
Fax Number	:

Provider Business Practice Location Address
First Line	:	4140 WOODLANDS PKWY
Second Line	:	SUITE B
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-3501
Country	:	US
Telephone Number	:	727-773-1013
Fax Number	:	813-635-2636

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	07/11/2012

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