MEDICARE: MR. TOBY ERIC 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	MD 37824	TN
2	207Q00000X	Family Medicine Physician	E-3513	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4198103	OTHER	TN	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588656730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TOBY ERIC ANDERSON MD

Provider Business Mailing Address
First Line	:	9705 OGLESBY RD
Second Line	:
City	:	MILLINGTON
State	:	TN
Zip	:	38053-4304
Country	:	US
Telephone Number	:	901-338-2188
Fax Number	:	901-872-4188

Provider Business Practice Location Address
First Line	:	9705 OGLESBY RD
Second Line	:
City	:	MILLINGTON
State	:	TN
Zip	:	38053-4304
Country	:	US
Telephone Number	:	901-338-2188
Fax Number	:	901-872-4188

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	10/08/2009

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Directions to “ MR. TOBY ERIC ANDERSON MD” Practice Location

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