Individual
DR. JOHN ANDERSON
Active
Individual
DR. JOHN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036103841
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036-103841
STATE LICENSE NUMBER
IL
01
—
P00015719
MEDICARE RAILROAD CARRIER
IL
Enumeration date
05/04/2006
Last updated
10/19/2018
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