MEDICARE: EDWARD ANDERSON DPM

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
1	213E00000X	Podiatrist	0197	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00733506	OTHER	IN	RAILROAD MEDICARE
3	480034923	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366445462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD ANDERSON DPM

Provider Business Mailing Address
First Line	:	PO BOX 1593
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42419-1593
Country	:	US
Telephone Number	:	270-830-6522
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 LETCHER ST
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42420-4245
Country	:	US
Telephone Number	:	270-830-6522
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	04/07/2017

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Directions to “ EDWARD ANDERSON DPM” Practice Location

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