MEDICARE: DEREK JAMES 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
1	207Q00000X	Family Medicine Physician	10793R	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	990008020	OTHER	LA	RAILROAD MEDICARE PIN
4	080179869	OTHER	LA	RAILROAD MEDICARE PIN
5	270663YJGU	OTHER	LA	MEDICARE PTAN

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568468171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK JAMES ANDERSON MD

Provider Business Mailing Address
First Line	:	1514 JEFFERSON HWY
Second Line	:	BLDG 200
City	:	NEW ORLEANS
State	:	LA
Zip	:	70121-2429
Country	:	US
Telephone Number	:	225-237-1754
Fax Number	:	225-237-1722

Provider Business Practice Location Address
First Line	:	9001 SUMMA AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-3726
Country	:	US
Telephone Number	:	225-761-5200
Fax Number	:	225-761-5487

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	04/29/2016

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Directions to “ DEREK JAMES ANDERSON MD” Practice Location

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