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NPI Code Detail

MEDICARE: DR. JOSEPH M ANDERSON DO

MEDICARE: DR. JOSEPH M ANDERSON DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician0-102ID
2207PE0005XUndersea and Hyperbaric Medicine (Emergency Medicine) Physician0-102ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
254547OTHERIDBLUE CROSS ID

General Provider Information

NPI Number : 1326025396
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSEPH M ANDERSON DO
Provider Business Mailing Address
First Line : PO BOX 1647
Second Line : 2860 CHANNING WAY SUITE 115
City : IDAHO FALLS
State : ID
Zip : 83403-1647
Country : US
Telephone Number : 208-535-4130
Fax Number : 208-535-4125
Provider Business Practice Location Address
First Line : 3100 CHANNING WAY
Second Line :
City : IDAHO FALLS
State : ID
Zip : 83404-7533
Country : US
Telephone Number : 208-535-4130
Fax Number : 208-535-4125
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2005
Last Update Date : 07/31/2012

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Directions to “ DR. JOSEPH M ANDERSON DO” Practice Location

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