Healthcare Provider Details

I. General information

NPI: 1861412447
Provider Name (Legal Business Name): SCOTT CHARLES ANDERSON AU.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1367 W HARVARD AVE
ROSEBURG OR
97471-2838
US

IV. Provider business mailing address

1367 W HARVARD AVE
ROSEBURG OR
97471-2838
US

V. Phone/Fax

Practice location:
  • Phone: 541-672-8868
  • Fax:
Mailing address:
  • Phone: 541-672-8868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number22952
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number22952
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: