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General NPI Number Information
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NPI Number | 1467483867
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Entity Type | Individual
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Provider Name | KENNETH ROBERT ANDERSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 15701 STATE ROAD 50SUITE 101 SUITE 101
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City | CLERMONT
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State | FL
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Zip | 34711
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Country | US
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Telephone | 352-394-7757
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Fax |
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Provider Business Mailing Address
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Address Line | 12815 KATHERINE CIR
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City | CLERMONT
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State | FL
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Zip | 34711-6703
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME69071
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License Number State | FL
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