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1780673343

NPI Code Detail

MEDICARE: PHILIP BRADLEY ANDERSON MD

MEDICARE: PHILIP BRADLEY ANDERSON MD

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	2084P0800X	Psychiatry Physician	MD18177	TN
2	2084P0800X	Psychiatry Physician	MD23029	OR

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
2	4225056	OTHER		AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0129072	OTHER	TN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1780673343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP BRADLEY ANDERSON MD

Provider Business Mailing Address
First Line	:	2700 SE STRATUS AVE
Second Line	:
City	:	MCMINNVILLE
State	:	OR
Zip	:	97128-6255
Country	:	US
Telephone Number	:	615-849-5685
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 SE STRATUS AVE
Second Line	:
City	:	MCMINNVILLE
State	:	OR
Zip	:	97128-6255
Country	:	US
Telephone Number	:	615-849-5685
Fax Number	:

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	02/15/2022

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Directions to “ PHILIP BRADLEY ANDERSON MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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