Healthcare Provider Details

I. General information

NPI: 1114906609
Provider Name (Legal Business Name): CHRISTOPHER ANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SUMTER DR
MOORESVILLE NC
28117-9620
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 704-660-6939
  • Fax:
Mailing address:
  • Phone: 505-923-5362
  • Fax: 505-923-5362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD2017-1020
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036142147
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number37998
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: