1780654376 NPI number — DALE C ANDERSON DPM

Table of content: DALE C ANDERSON DPM (NPI 1780654376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780654376 NPI number — DALE C ANDERSON DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
DALE
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780654376
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6801 US HIGHWAY 27 N
Provider Second Line Business Mailing Address:
#D3
Provider Business Mailing Address City Name:
SEBRING
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33870-7840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-314-8600
Provider Business Mailing Address Fax Number:
863-314-8556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6801 US HIGHWAY 27 N
Provider Second Line Business Practice Location Address:
#D3
Provider Business Practice Location Address City Name:
SEBRING
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33870-7840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-314-8600
Provider Business Practice Location Address Fax Number:
863-314-8556
Provider Enumeration Date:
01/25/2006

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: 213ES0103X , with the licence number:  PO2915 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9942617 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: N232158 . This is a "HEALTHEASE KID CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 16669 . This is a "FL HOSPITAL HEALTHCARE SY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 65709 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00158441 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 340223100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002122232 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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