Provider Demographics
NPI:1326094624
Name:ANDERSON, JOHN B (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5213 S ALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4430
Mailing Address - Country:US
Mailing Address - Phone:919-620-4917
Mailing Address - Fax:919-620-4921
Practice Address - Street 1:101-A PROFESSIONAL PARK DR.
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27563
Practice Address - Country:US
Practice Address - Phone:919-693-3972
Practice Address - Fax:919-693-1700
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2012-05-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC27014207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC82603Medicare UPIN