Provider Demographics
NPI:1659608578
Name:ANDERSON, JEFFREY G (MT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:G
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MEDICAL UNIT
Mailing Address - Street 2:PSC 461, BOX 50
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96521-0050
Mailing Address - Country:US
Mailing Address - Phone:801-542-9751
Mailing Address - Fax:
Practice Address - Street 1:PSC 461
Practice Address - Street 2:MEDICAL UNIT
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96521-0050
Practice Address - Country:US
Practice Address - Phone:86108-531-4447
Practice Address - Fax:86108-531-3888
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist