# DEREK JAMES ANDERSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1568468171
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 10793R | LA | Yes |

## Other

- **Enumeration date:** 06/28/2005
- **Last updated:** 04/29/2016

## 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 |