Provider Demographics
NPI:1679579825
Name:ANDERSON, PATRICIA J (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2507 HARRISON AVE.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405
Mailing Address - Country:US
Mailing Address - Phone:850-215-5911
Mailing Address - Fax:850-914-3004
Practice Address - Street 1:1847 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4640
Practice Address - Country:US
Practice Address - Phone:850-890-1719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82277207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
390007574OtherRRB PTAN
FL261089200Medicaid
E92089Medicare UPIN
58820Medicare PIN