Provider Demographics
NPI:1265428163
Name:ANDERSON, JANET (MD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 37TH ST STE C105
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7301
Mailing Address - Country:US
Mailing Address - Phone:772-794-7791
Mailing Address - Fax:772-794-7794
Practice Address - Street 1:777 37TH ST STE C105
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7301
Practice Address - Country:US
Practice Address - Phone:772-794-7791
Practice Address - Fax:772-794-7794
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61810207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263063000Medicaid
FLE53602Medicare UPIN
FLK2308AMedicare ID - Type Unspecified