Healthcare Provider Details

I. General information

NPI: 1568468171
Provider Name (Legal Business Name): DEREK JAMES ANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 SUMMA AVE
BATON ROUGE LA
70809-3726
US

IV. Provider business mailing address

1514 JEFFERSON HWY BLDG 200
NEW ORLEANS LA
70121-2429
US

V. Phone/Fax

Practice location:
  • Phone: 225-761-5200
  • Fax: 225-761-5487
Mailing address:
  • Phone: 225-237-1754
  • Fax: 225-237-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10793R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: