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NPI Code Detail

MEDICARE: DR. JOHN WESLEY ANDERSON MD

MEDICARE: DR. JOHN WESLEY ANDERSON MD
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
12084P0800XPsychiatry PhysicianMD10618OR

Other Identifiers

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

General Provider Information

NPI Number : 1558350611
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN WESLEY ANDERSON MD
Provider Business Mailing Address
First Line : 3439 NE SANDY BLVD
Second Line : PMB 375
City : PORTLAND
State : OR
Zip : 97232-1959
Country : US
Telephone Number : 503-284-8841
Fax Number : 503-282-3302
Provider Business Practice Location Address
First Line : 9450 SW BARNES RD
Second Line : NUMBER 230
City : PORTLAND
State : OR
Zip : 97225-6619
Country : US
Telephone Number : 503-292-6238
Fax Number : 503-292-0987
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2005
Last Update Date : 07/08/2007

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