Individual
JACK W. ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
470 TAYLOR RD, MONTGOMERY, AL 36117-3563
(334) 226-4048
(334) 323-5675
Mailing address
2151 OLD ROCKY RIDGE ROAD, SUITE 106, BIRMINGHAM, AL 35216-7251
(205) 989-1080
(205) 989-1087
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD.16671
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050071018
MEDICARE RR
AL
05
—
214426
—
AL
01
—
510-45874
BCBS
AL
Enumeration date
03/07/2006
Last updated
09/26/2019
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