Provider Demographics
NPI:1407811722
Name:ANDERSON, JEFFREY B (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:B
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 1:222 22ND AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1852
Mailing Address - Country:US
Mailing Address - Phone:629-255-3486
Mailing Address - Fax:
Practice Address - Street 1:222 22ND AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1852
Practice Address - Country:US
Practice Address - Phone:629-255-2198
Practice Address - Fax:629-255-4173
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN55777207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ028588Medicaid
KYH46239Medicare UPIN
TNQ028588Medicaid
1198883OtherCHA / NCMA
2440485000OtherPASSPORT ADVANTAGE / NCMA
KY64055247Medicaid
000000252333OtherANTHEM / NCMA
017242OtherSIHO / NCMA
KYH46239Medicare UPIN
4069807001OtherCIGNA / NCMA
TNQ028588Medicaid