1871190413 NPI number — DR. CALEB DANIEL ANDERS PST.023506

Table of content: STACY OTT (NPI 1346567336)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871190413 NPI number — DR. CALEB DANIEL ANDERS PST.023506

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERS
Provider First Name:
CALEB
Provider Middle Name:
DANIEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PST.023506
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANDERS
Provider Other First Name:
CALEB
Provider Other Middle Name:
DANIEL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1871190413
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1333 COATES BLUFF DR APT 721
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71104-2820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-557-7029
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 E STONER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71101-4243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-863-7441
Provider Business Practice Location Address Fax Number:
318-990-5750
Provider Enumeration Date:
10/06/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PST.023506 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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