Healthcare Provider Details

I. General information

NPI: 1356507149
Provider Name (Legal Business Name): ERIC CHRISTOPHER ANDERSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 N MAIN ST SUITE 3100
BELLEFONTAINE OH
43311-2379
US

IV. Provider business mailing address

205 E PALMER RD
BELLEFONTAINE OH
43311-2281
US

V. Phone/Fax

Practice location:
  • Phone: 937-599-1280
  • Fax: 937-651-6442
Mailing address:
  • Phone: 937-592-4015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36003530
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: