Individual
ANSEL GLEN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD40430
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3335732
—
TN
01
—
4118861
BCBS PROVIDER NUMBER
TN
01
—
P00313053
RAILROAD MEDICARE
TN
Enumeration date
05/18/2006
Last updated
04/14/2008
Update your record
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