Provider Demographics
NPI:1629007174
Name:ANDERSON, JOHN VIRGIL JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:VIRGIL
Last Name:ANDERSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4401 WORNALL RD
Mailing Address - Street 2:2718
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3220
Mailing Address - Country:US
Mailing Address - Phone:816-932-2493
Mailing Address - Fax:819-932-5814
Practice Address - Street 1:4401 WORNALL RD
Practice Address - Street 2:2718
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3220
Practice Address - Country:US
Practice Address - Phone:816-932-2493
Practice Address - Fax:816-932-5814
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR5C032080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine