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General NPI Number Information
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NPI Number | 1033753926
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Entity Type | Individual
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Provider Name | CONNOR JAMES ANDERSON PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/04/2019
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Last Update Date | 06/14/2022
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Provider Practice Location Address
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Address Line | 3004 HAYES AVE
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City | SANDUSKY
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State | OH
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Zip | 44870-5321
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Country | US
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Telephone | 419-626-6161
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Fax |
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Provider Business Mailing Address
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Address Line | 428 COUNTRY WALK
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City | AMHERST
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State | OH
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Zip | 44001-2635
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Country | US
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Telephone | 440-308-5589
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.006120RX
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License Number State | OH
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