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General NPI Number Information
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NPI Number | 1154035053
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Entity Type | Individual
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Provider Name | MR. DAVID MICHAEL ANDERSON III
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Gender | Male
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Dates
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Enumeration Date | 01/06/2023
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Last Update Date | 01/06/2023
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Provider Practice Location Address
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Address Line | 204 N ELM AVE STE 102
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City | SANFORD
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State | FL
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Zip | 32771-1272
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Country | US
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Telephone | 407-878-0048
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Fax | 407-878-7099
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Provider Business Mailing Address
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Address Line | 204 N ELM AVE STE 102
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City | SANFORD
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State | FL
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Zip | 32771-1272
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Country | US
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Telephone | 407-878-0048
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Fax | 407-878-7099
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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 | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number | 30212329
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License Number State | FL
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