Healthcare Provider Details

I. General information

NPI: 1760143986
Provider Name (Legal Business Name): C JAMES ANDERSON DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11710 OLD BALLAS RD STE 110
SAINT LOUIS MO
63141-7076
US

IV. Provider business mailing address

PO BOX 3681
SPRINGFIELD IL
62708-3681
US

V. Phone/Fax

Practice location:
  • Phone: 618-277-9533
  • Fax: 618-277-9540
Mailing address:
  • Phone: 618-277-9533
  • Fax: 618-277-9540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MELISSA BAUER
Title or Position: BILLING MANAGER
Credential:
Phone: 618-277-9533