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General NPI Number Information
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NPI Number | 1487934865
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Entity Type | Individual
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Provider Name | JEFFREY DREW ANDERSON P.A.-C.
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Gender | Male
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Dates
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Enumeration Date | 08/17/2011
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Last Update Date | 06/19/2013
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Provider Practice Location Address
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Address Line | 1638 OWEN DRIVE CAPE FEAR VALLEY MEDICAL CENTER EMERGENCY DEPARTMENT
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-2000
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Country | US
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Telephone | 910-615-8000
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Fax | 910-321-6250
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Provider Business Mailing Address
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Address Line | P.O. BOX 2000 1638 OWEN DRIVE CAPE FEAR VALLEY MEDICAL CENTER EMERGENCY DEPARTMENT
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-2000
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Country | US
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Telephone | 910-615-8000
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Fax | 910-321-6250
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | C5-0000768
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA054881
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0010-04177
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License Number State | NC
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