Provider Demographics
NPI:1326011719
Name:ANDERSON, JOHN T (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:T
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PLAZA
Mailing Address - Street 2:STE 900
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-2643
Mailing Address - Country:US
Mailing Address - Phone:205-271-8000
Mailing Address - Fax:205-271-8050
Practice Address - Street 1:1 INDEPENDENCE PLAZA
Practice Address - Street 2:STE 900
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-2643
Practice Address - Country:US
Practice Address - Phone:205-271-8000
Practice Address - Fax:205-271-8050
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-084090367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL31615OtherBC
AL31615OtherBC
Q20375Medicare UPIN