MEDICARE: DAVID S ANDERSON MD INC

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	207R00000X	Internal Medicine Physician	MD0000011770	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110011398	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0043803	OTHER		BC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528071974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID S ANDERSON MD INC

Provider Business Mailing Address
First Line	:	1860 EXECUTIVE PARK
Second Line	:	SUITE B
City	:	CLEVELAND
State	:	TN
Zip	:	37312-2756
Country	:	US
Telephone Number	:	423-476-7584
Fax Number	:	423-476-7586

Provider Business Practice Location Address
First Line	:	1860 EXECUTIVE PARK
Second Line	:	SUITE B
City	:	CLEVELAND
State	:	TN
Zip	:	37312-2756
Country	:	US
Telephone Number	:	423-476-7584
Fax Number	:	423-476-7586

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID SCOTT ANDERSON
Credential	:	MD
Telephone Number	:	423-476-7584

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	02/10/2010

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