Provider Demographics
NPI:1497715833
Name:ANDERSON, JEFFERY STUART (MD)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:STUART
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:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:COLLETTSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28611-0009
Mailing Address - Country:US
Mailing Address - Phone:828-754-2409
Mailing Address - Fax:
Practice Address - Street 1:1345 NC HIGHWAY 268
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-9027
Practice Address - Country:US
Practice Address - Phone:828-754-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39759207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911157Medicaid
NC8911141Medicaid
NCNC5824BMedicare PIN
NC8911157Medicaid