Healthcare Provider Details

I. General information

NPI: 1679579825
Provider Name (Legal Business Name): PATRICIA J ANDERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1847 FLORIDA AVE
PANAMA CITY FL
32405-4640
US

IV. Provider business mailing address

2507 HARRISON AVE. SUITE 101
PANAMA CITY FL
32405
US

V. Phone/Fax

Practice location:
  • Phone: 850-890-1719
  • Fax:
Mailing address:
  • Phone: 850-215-5911
  • Fax: 850-914-3004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME82277
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: