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General NPI Number Information
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NPI Number | 1750643060
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Entity Type | Organization
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Legal Business Name | JOHN C. ANDERSON, M.D., P.C.
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Dates
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Enumeration Date | 06/12/2012
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Last Update Date | 02/24/2013
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Provider Practice Location Address
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Address Line | 831 NW COUNCIL DR SUITE 130
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City | GRESHAM
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State | OR
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Zip | 97030-3721
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Country | US
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Telephone | 503-489-1122
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Fax | 503-489-1123
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Provider Business Mailing Address
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Address Line | 831 NW COUNCIL DR SUITE 130
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City | GRESHAM
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State | OR
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Zip | 97030-3721
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Country | US
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Telephone | 503-489-1122
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Fax | 503-489-1123
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Authorized Official
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Title or Position | OWNER
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Name | JOHN ANDERSON
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Credential | M.D.
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Telephone | 503-489-1122
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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 | MD26880
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License Number State | OR
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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 | MD26880
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License Number State | OR
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