Individual
MARK WESLEY ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
1079 VENDALL RD, DYERSBURG, TN 38024-1622
(731) 286-6006
(731) 286-5570
Mailing address
659 ANDERSON RD, DYERSBURG, TN 38024-8401
(731) 286-6006
(731) 286-5570
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
—
—
224P00000X
Prosthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1454453
—
TN
Enumeration date
06/07/2006
Last updated
03/25/2008
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