Healthcare Provider Details

I. General information

NPI: 1316309891
Provider Name (Legal Business Name): DR. HARRY J.ANDERSON,JR.,M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 E CHEYENNE MOUNTAIN BLVD
COLORADO SPRINGS CO
80906-3718
US

IV. Provider business mailing address

190 E CHEYENNE MOUNTAIN BLVD
COLORADO SPRINGS CO
80906-3718
US

V. Phone/Fax

Practice location:
  • Phone: 719-576-7337
  • Fax:
Mailing address:
  • Phone: 719-576-7337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21329
License Number StateCO

VIII. Authorized Official

Name: MS. JANIECE CARLSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 719-576-7921