Provider Demographics
NPI:1750680567
Name:ANDERSON, GARLAND EDWARD II (MD)
Entity Type:Individual
Prefix:DR
First Name:GARLAND
Middle Name:EDWARD
Last Name:ANDERSON
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 AVENUE F
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3600
Mailing Address - Country:US
Mailing Address - Phone:985-732-0058
Mailing Address - Fax:
Practice Address - Street 1:1416 GOBBLER HEAD DR
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-6091
Practice Address - Country:US
Practice Address - Phone:985-732-4853
Practice Address - Fax:985-735-8883
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA205805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2149610Medicaid