Individual
GARY LEE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
101 WALNUT ST, KANE, PA 16735-1277
(814) 975-1033
(814) 975-1036
Mailing address
101 WALNUT ST, KANE, PA 16735-1277
(814) 975-1033
(814) 975-1036
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
OS007179L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014607020003
—
PA
Enumeration date
08/14/2006
Last updated
11/14/2019
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