Provider Demographics
NPI:1295853018
Name:ANDERSON, STEVEN R (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 W PARK DR
Mailing Address - Street 2:ORTHOPAEDIC SPECIALISTS OF WILKES
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-3585
Mailing Address - Country:US
Mailing Address - Phone:336-903-7845
Mailing Address - Fax:336-903-7841
Practice Address - Street 1:1917 W PARK DR
Practice Address - Street 2:ORTHOPAEDIC SPECIALISTS OF WILKES
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3585
Practice Address - Country:US
Practice Address - Phone:336-903-7845
Practice Address - Fax:336-903-7841
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200700211207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5906404Medicaid
NC206554AOtherMEDICARE PTAN, INDIVIDUAL
NC2335816OtherMEDICARE PTAN, GROUP
NC2065544OtherMEDICARE PTAN, INDIVIDUAL