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General NPI Number Information
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NPI Number | 1093246290
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Entity Type | Individual
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Provider Name | FORREST LOYD ANDERSON MD
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Gender | Male
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Dates
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Enumeration Date | 03/21/2017
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 206 CORNELIA ST
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City | PLATTSBURGH
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State | NY
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Zip | 12901-2878
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Country | US
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Telephone | 518-314-3560
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Fax |
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Provider Business Mailing Address
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Address Line | 622 W 168TH ST PH 11
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City | NEW YORK
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State | NY
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Zip | 10032-3720
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Country | US
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Telephone | 122-305-2500
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | A174992
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 321571
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License Number State | NY
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