Provider Demographics
NPI:1184790479
Name:ANTHONY, JOHN LEE (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LEE
Last Name:ANTHONY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4712 BERRY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-3080
Mailing Address - Country:US
Mailing Address - Phone:334-834-3094
Mailing Address - Fax:334-263-0598
Practice Address - Street 1:4712 BERRY BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3080
Practice Address - Country:US
Practice Address - Phone:334-834-3094
Practice Address - Fax:334-263-0598
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL19714207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALF61004Medicare UPIN
AL000008445Medicare ID - Type Unspecified