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General NPI Number Information
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NPI Number | 1679524094
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Entity Type | Individual
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Provider Name | ANTHONY ANDERSON MD
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Gender | Male
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1479A U.S. HIGHWAY 61
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City | FESTUS
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State | MO
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Zip | 63028-4123
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Country | US
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Telephone | 636-931-5533
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Fax | 636-931-5502
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Provider Business Mailing Address
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Address Line | 1479A U.S. HIGHWAY 61
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City | FESTUS
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State | MO
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Zip | 63028-4123
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Country | US
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Telephone | 636-931-5533
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Fax | 636-931-5502
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MDR7H67
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036119093
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 036119093
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 036119093
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036119093
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License Number State | IL
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