Provider Demographics
NPI:1114147477
Name:ANDERSON, JOEL BROUGHER (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:BROUGHER
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1316 MERCY DR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1835
Mailing Address - Country:US
Mailing Address - Phone:231-739-9461
Mailing Address - Fax:231-733-8131
Practice Address - Street 1:1316 MERCY DR
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1835
Practice Address - Country:US
Practice Address - Phone:231-739-9461
Practice Address - Fax:231-733-8131
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35091326208600000X
MI4301081902208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery