Provider Demographics
NPI:1205187291
Name:ANDERSON, DANIEL LEROY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:LEROY
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4204 COLONIAL AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-2932
Mailing Address - Country:US
Mailing Address - Phone:678-429-2079
Mailing Address - Fax:
Practice Address - Street 1:US NAVAL HOSPITAL OKINAWA
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96350-1600
Practice Address - Country:US
Practice Address - Phone:315-643-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant