Individual
MR. BENJAMIN THOMAS ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1101 MICHIGAN AVE, LOGANSPORT, IN 46947-1528
(574) 753-7541
Mailing address
1101 MICHIGAN AVE, LOGANSPORT, IN 46947-1528
(574) 753-7541
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
02004299A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000881873
ANTHEM
IN
05
—
201094390
—
IN
01
—
P01342297
MCR RAILROAD
IN
Enumeration date
03/24/2011
Last updated
06/29/2015
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