Healthcare Provider Details

I. General information

NPI: 1275577389
Provider Name (Legal Business Name): JAMES C ANDERSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 09/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 RIVERSIDE AVE SUITE C
FORT COLLINS CO
80524-4366
US

IV. Provider business mailing address

1355 RIVERSIDE AVE SUITE C
FORT COLLINS CO
80524-4366
US

V. Phone/Fax

Practice location:
  • Phone: 970-484-4620
  • Fax:
Mailing address:
  • Phone: 970-484-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD.0000350
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPOD.0000350
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: