Healthcare Provider Details

I. General information

NPI: 1497209019
Provider Name (Legal Business Name): JEFF ANDERSON SA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 07/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9517 BIGHORN WAY
LITTLETON CO
80125
US

IV. Provider business mailing address

9517 BIGHORN WAY
LITTLETON CO
80125
US

V. Phone/Fax

Practice location:
  • Phone: 303-550-7383
  • Fax:
Mailing address:
  • Phone: 303-550-7383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number0001055
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: