1790760494 NPI number — DR. CHRISTOPHER JAMES ANDERSON DPM

Table of content: DR. CHRISTOPHER JAMES ANDERSON DPM (NPI 1790760494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790760494 NPI number — DR. CHRISTOPHER JAMES ANDERSON DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
CHRISTOPHER
Provider Middle Name:
JAMES
Provider Name Prefix Text:
DR.
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:
1790760494
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
717 INSIGHT AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
O'FALLON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62269
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-277-9533
Provider Business Mailing Address Fax Number:
618-277-9540

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
717 INSIGHT AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
O'FALLON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-277-9533
Provider Business Practice Location Address Fax Number:
618-277-9540
Provider Enumeration Date:
12/14/2005

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: 213ES0131X , with the licence number:  2010030718 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0131X , with the licence number: 016.005443 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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