Healthcare Provider Details

I. General information

NPI: 1124400759
Provider Name (Legal Business Name): DOUGLAS H ANDERSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HARRODSBURG RD STE B275
LEXINGTON KY
40504-1775
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-2334
  • Fax: 859-278-0159
Mailing address:
  • Phone: 606-330-7835
  • Fax: 859-278-0159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC5084
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberC5084
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberH0094232
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: