Individual
DR. MARCUS WALTER ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
400 HEALTH PARK BLVD, ST AUGUSTINE, FL 32086-5784
(904) 819-4565
(904) 819-4999
Mailing address
400 HEALTH PARK BLVD, ST AUGUSTINE, FL 32086-5784
(904) 819-4040
(904) 819-4041
Taxonomy
Speciality
Code
Description
License number
State
2084F0202X
Forensic Psychiatry Physician
Primary
ME105840
FL
2084P0800X
Psychiatry Physician
TRN10998
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116379300
—
FL
01
—
14N4N
BCBS
FL
Enumeration date
07/04/2007
Last updated
02/12/2013
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