Provider Demographics
NPI:1639561277
Name:ANDERSON FOOT AND ANKLE INSTITUTE, INC
Entity Type:Organization
Organization Name:ANDERSON FOOT AND ANKLE INSTITUTE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIER
Authorized Official - Middle Name:DESELLE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:318-884-7917
Mailing Address - Street 1:2106 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2604
Mailing Address - Country:US
Mailing Address - Phone:318-884-7917
Mailing Address - Fax:
Practice Address - Street 1:6198 CYPRESS ST
Practice Address - Street 2:BUILDING #2
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-9010
Practice Address - Country:US
Practice Address - Phone:318-397-6360
Practice Address - Fax:318-397-6399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADPM.200039213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty