Healthcare Provider Details

I. General information

NPI: 1053384362
Provider Name (Legal Business Name): JOHN M ANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 WEST 4TH NORTH STREET DEPT OF RADIATION ONCOLOGY
MORRISTOWN TN
37814-3894
US

IV. Provider business mailing address

DEPT 888025
KNOXVILLE TN
37995-8025
US

V. Phone/Fax

Practice location:
  • Phone: 423-522-5000
  • Fax: 423-522-4901
Mailing address:
  • Phone: 512-583-0205
  • Fax: 512-583-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD35666
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: