Provider Demographics
NPI:1609836840
Name:ANDERSON, PHILEMON LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILEMON
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PHIL
Other - Middle Name:LYNN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:718 NE 87TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-1970
Mailing Address - Country:US
Mailing Address - Phone:360-828-1346
Mailing Address - Fax:360-828-7627
Practice Address - Street 1:718 NE 87TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1970
Practice Address - Country:US
Practice Address - Phone:360-828-1346
Practice Address - Fax:360-828-7627
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034870207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology