Provider Demographics
NPI:1497209019
Name:ANDERSON, JEFF (SA)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:SA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9517 BIGHORN WAY
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80125
Mailing Address - Country:US
Mailing Address - Phone:303-550-7383
Mailing Address - Fax:
Practice Address - Street 1:9517 BIGHORN WAY
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80125
Practice Address - Country:US
Practice Address - Phone:303-550-7383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2018-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001055246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant