Individual
JUSTIN BRANDON ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2401 W UNIVERSITY AVE, MUNCIE, IN 47303-3428
(765) 741-1515
(765) 751-5087
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01072226A
IN
208M00000X
Hospitalist Physician
01072226A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201094940
—
IN
01
—
M22404099
MEDICARE PTAN
IN
01
—
P01253299
RAILROAD MEDICARE
IN
Enumeration date
06/11/2010
Last updated
04/23/2024
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