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Individual
DR. KELLY R ANDERSON
Active
Individual
DR. KELLY R ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
02001311A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000110680
ANTHEM
IN
05
—
200022500
—
IN
Enumeration date
09/23/2005
Last updated
04/20/2018
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