Individual
PHAN TASCO ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
203 GREYTHORNE DR, KATHLEEN, GA 31047-5304
(719) 337-9392
Mailing address
203 GREYTHORNE DR, KATHLEEN, GA 31047-5304
(719) 337-9392
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1457
CO
Other
Enumeration date
02/02/2007
Last updated
01/18/2012
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