Individual
JACK D ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7030 PINEVILLE MATTHEWS RD, CHARLOTTE, NC 28226-8298
(704) 667-4150
(704) 752-7040
Mailing address
PO BOX 601067, CHARLOTTE, NC 28260-1067
(704) 667-4150
(704) 752-7040
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
30586
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11152
BCBS
NC
05
—
8911152
—
NC
05
—
N30586
—
SC
Enumeration date
07/19/2006
Last updated
06/25/2013
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