Organization
RUSSELL SCOTT ANDERSON MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL SCOTT ANDERSON MD (CHIEF EXECUTIVE OFFICER)
(601) 479-1928
Entity
Organization
Contact information
Practice address
1704 23RD AVENUE, MERIDIAN, MS 39301
(601) 485-5081
(601) 485-5084
Mailing address
PO BOX 8580, MERIDIAN, MS 39303-8580
(601) 479-1554
(601) 564-0511
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
13362
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00121517
—
MS
01
—
225866645B
BLUE CROSS BLUE SHIELD
MS
Enumeration date
09/20/2006
Last updated
08/26/2020
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