Provider Demographics
NPI:1942819875
Name:ANDERSON, DAVID MELVILLE
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MELVILLE
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2558 S ANAHEIM ST APT 102
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1482
Mailing Address - Country:US
Mailing Address - Phone:719-440-9242
Mailing Address - Fax:
Practice Address - Street 1:2558 S ANAHEIM ST APT 102
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1482
Practice Address - Country:US
Practice Address - Phone:719-440-9242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider