Individual
JACK ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9787 N 91ST ST STE 101, SCOTTSDALE, AZ 85258-5088
(480) 563-6400
(480) 563-8009
Mailing address
9787 N 91ST ST STE 101, SCOTTSDALE, AZ 85258-5088
(480) 563-6400
(480) 563-8009
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
24265
OK
207P00000X
Emergency Medicine Physician
Primary
R5501
TX
208VP0000X
Pain Medicine Physician
45727
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200055660A
—
OK
Enumeration date
05/01/2006
Last updated
11/21/2024
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