Provider Demographics
NPI:1356478242
Name:ANDERSON, JAMES HOWARD
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:HOWARD
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RAMS WAY
Mailing Address - Street 2:
Mailing Address - City:EARTH CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63045-1523
Mailing Address - Country:US
Mailing Address - Phone:314-516-8736
Mailing Address - Fax:314-516-8777
Practice Address - Street 1:1 RAMS WAY
Practice Address - Street 2:
Practice Address - City:EARTH CITY
Practice Address - State:MO
Practice Address - Zip Code:63045-1523
Practice Address - Country:US
Practice Address - Phone:314-516-8736
Practice Address - Fax:314-516-8777
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1105202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer