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NPI Code Detail

MEDICARE: DR. PATRICIA J ANDERSON M.D.

MEDICARE: DR. PATRICIA J ANDERSON M.D.
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
1207RN0300XNephrology PhysicianME82277FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1390007574OTHERRRB PTAN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679579825
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PATRICIA J ANDERSON M.D.
Provider Business Mailing Address
First Line : 2507 HARRISON AVE.
Second Line : SUITE 101
City : PANAMA CITY
State : FL
Zip : 32405
Country : US
Telephone Number : 850-215-5911
Fax Number : 850-914-3004
Provider Business Practice Location Address
First Line : 1847 FLORIDA AVE
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-4640
Country : US
Telephone Number : 850-890-1719
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2005
Last Update Date : 04/18/2018

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