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Individual
DEREK JAMES ANDERSON
Active
Individual
DEREK JAMES ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10793R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00876731
—
MS
01
—
080179869
RAILROAD MEDICARE PIN
LA
05
—
1996254
—
LA
01
—
270663YJGU
MEDICARE PTAN
LA
01
—
990008020
RAILROAD MEDICARE PIN
LA
Enumeration date
06/28/2005
Last updated
04/29/2016
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