Individual
MR. JON E ANDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
390 MAPLE SUMMIT RD, JERSEYVILLE, IL 62052-2000
(618) 498-2101
(618) 498-2787
Mailing address
390 MAPLE SUMMIT RD, JERSEYVILLE, IL 62052-2000
(618) 498-7518
(618) 498-3052
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036102731
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036102731
—
IL
01
—
067210
HEALTH ALLIANCE
IL
01
—
11807598
CAQH ID
IL
01
—
431532
HEALTHLINK
IL
01
—
784310
MEDICARE
IL
Enumeration date
08/18/2006
Last updated
11/13/2024
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