Provider Demographics
NPI:1376634964
Name:ANDERSON, JAMES NOBLE JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:NOBLE
Last Name:ANDERSON
Suffix:JR
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 1:1773 PLATT PL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7762
Mailing Address - Country:US
Mailing Address - Phone:334-284-5470
Mailing Address - Fax:334-284-9714
Practice Address - Street 1:1773 PLATT PL
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7762
Practice Address - Country:US
Practice Address - Phone:334-284-5470
Practice Address - Fax:334-284-9714
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15297207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL040010445OtherRAILROAD MEDICARE
AL051027090OtherBLUE CROSS BLUE SHIELD
AL000027090Medicaid
E92603Medicare UPIN
AL000027090Medicare PIN