Provider Demographics
NPI:1487645990
Name:MCPHERRON, ANTHONY A (DO)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:A
Last Name:MCPHERRON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2800 REX GROSSMAN BLVD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-5145
Practice Address - Country:US
Practice Address - Phone:317-944-9400
Practice Address - Fax:317-963-1955
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002167207XS0114X
VA0102203565207XS0114X
NC2017-00062207XS0114X
IN02002167A207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC207X00000XMedicaid
VA1487645990Medicaid
IN264430H51OtherMEDICARE PTAN
IN200038716OtherRAILROAD MEDICARE
NC207XS0114XMedicaid
IN300078947Medicaid
VAVVB294AMedicare PIN