Provider Demographics
NPI:1952644007
Name:ANDERS, ANDY JOHN (CP, LP)
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:JOHN
Last Name:ANDERS
Suffix:
Gender:M
Credentials:CP, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1614 GREENBRIAR PL
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7641
Mailing Address - Country:US
Mailing Address - Phone:405-415-5862
Mailing Address - Fax:405-605-3041
Practice Address - Street 1:1614 GREENBRIAR PL
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7641
Practice Address - Country:US
Practice Address - Phone:405-415-5862
Practice Address - Fax:405-605-3041
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK27224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist