Healthcare Provider Details

I. General information

NPI: 1154302677
Provider Name (Legal Business Name): SCOTT A ANDERSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 SOUTHWEST BLVD
JEFFERSON CITY MO
65109-2444
US

IV. Provider business mailing address

1432 SOUTHWEST BLVD
JEFFERSON CITY MO
65109-2444
US

V. Phone/Fax

Practice location:
  • Phone: 573-632-4800
  • Fax: 573-632-4890
Mailing address:
  • Phone: 573-632-4800
  • Fax: 573-632-4890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberR8G43
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: