Individual
DR. LUIS M ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3670 US 1 S STE 300B, SAINT AUGUSTINE, FL 32086-6354
(904) 479-9501
(904) 217-0524
Mailing address
3670 US 1 S STE 300B, SAINT AUGUSTINE, FL 32086-6354
(904) 479-9501
(904) 217-0524
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME0089595
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269304600
—
FL
01
—
37560
BCBS
FL
01
—
650598984
TAX ID
FL
01
—
7201378
AETNA
FL
Enumeration date
01/02/2007
Last updated
02/01/2020
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